Jessica got an alarming call from a friend this past April. Jessica, whose name has been changed to protect her and her friend’s privacy, hadn’t seen or talked to him in a few years. He was audibly drunk, says the 29-year-old who lives in New York City; he told her he was going to kill himself. She called 988 three different times in two hours, and each time a different person told her to hang up and call 911.
Sixty-year-old Scott says that during the wee hours of the night, when he is suicidal but can’t call his psychologist or psychiatrist and doesn’t want to wake a family member or friend, he’s briefly considered calling that same 988 number – the 988 Suicide and Crisis Lifeline. But Scott, whose name has been changed because of the sensitive nature of his story, hasn’t yet out of fear that gun-toting police officers will show up at his New Jersey home and forcibly drag him to a mental hospital.
Jen Basinger says the 988 hotline saved her life – not just once, but over and over, since the mental health line launched two years ago. The 50-year-old from Ohio says she’s called 988 more than 50 times, sometimes because she’s suicidal, othertimes just to talk to a stranger. And it has always helped.
In July 2022, the National Suicide Prevention Lifeline became the 988 Suicide and Crisis Lifeline, shifting from 10 digits to three and expanding its reach to include a range of mental health needs. Since then, call centers have fielded more than 10 million calls, chats and texts from every state, as well as Washington, D.C., and Puerto Rico.
The year 988 debuted, data from the U.S. Centers for Disease Control and Prevention showed that in the U.S., suicide had reached a record high, with more than 49,000 confirmed suicides, 80 percent of them men. A report by Pew Charitable Trust, “America’s Mental Health Crisis,” published in December 2023, shows that since the COVID-19 pandemic, 38 percent more people are in mental health care than before. But there’s not always help available. Data compiled by the Health Resources and Services Administration (HRSA) shows that 160 million Americans are in what amounts to mental health deserts.
Like 911, the three-digit 988 lifeline number was created because it’s easier to remember, says Hannah Wesolowski, chief advocacy officer at the National Alliance on Mental Illness (NAMI). However, a NAMI/Ipsos poll in June found that only 23 percent of respondents said they are “somewhat familiar with 988.”
“We know we need that number to be much higher,” says Wesolowski. “A lot of people are often worried about taking this resource away from somebody else if their crisis isn’t, quote, unquote serious enough. If it’s a crisis for you, it’s a crisis. There isn’t a threshold.”
Since last year, text messages to 988 have increased 51 percent and calls 34 percent. “We’re trying to implement this system on a fast track,” she says, because of high demand and climbing suicide rates, up 16 percent since the 2011-2022 reporting period.
Congress gave a total of $1 billion to states to build out their 988 hotlines. Reporting shows, however, that the success of 988 is directly linked to each state’s existing mental health infrastructure. Take response rates, for example. While federal data from May of this year shows an average, overall national response rate of 89 percent, the numbers vary widely from state to state: 97 percent of 988 calls in Mississippi, Montana and Rhode Island were answered. In Washington, D.C., the answer rate was 85 percent, Colorado response rates were in the low 70s, the reponse rates are below 70 percent in Illinois, and in Nevada, fewer than 64 percent of 988 calls were answered.
Response rates, however, don’t tell the whole story. Arizona, which had a 72 percent response rate in May, is considered a model for crisis care, having built up its mental health crisis response systems for the past 30 years. Their continuum of care includes mobile units (similar systems are used in 20 other states) and Crisis Stabilization Centers, designed to help those in serious psychiatric distress – no other state in the country has crisis centers like Arizona’s. But what works there may not necessarily be the solution everywhere, says Wesolowski.
While the goal is a system in which every caller has a comparable experience, Wesolowski believes the system still a few years away from that. Further, she says that it will require not only a coordinated effort by the federal government, states, territories and tribes, but also the building of a national back-up system to ensure that calls and texts are answered no matter a state’s capacity. She also hates when people are afraid to call.
Worries about anonymity and the kind of help they’ll receive is a concern for about a quarter of the population. While 72 percent of Americans responding to the NAMI/Ipsos poll said they would be comfortable calling 988, Scott isn’t one of them. “More scary than the actual trying – attempting suicide – was being in various hospitals and facilities where you’re locked in and you can’t leave, and those just scare me to death. That’s what’s stopping me from calling 988,” he says. That’s exactly what happened to Scott in the past when he was suicidal and his then-wife called 911 and he was hospitalized by police. “This fear is prevalent and repeated often. It comes from a place of real trauma,” says Wesolowski.
However, the 988 and crisis system is meant to reduce law enforcement involvement and hospitalization, she says. “Unlike 911, contacting 988 is the intervention and [using it] drastically reduces in-person responses. But the fear is based on real experiences, and an uphill battle for this system to climb,” says Wesolowski. Unlike 911’s system, which tracks where a call comes from, 988 is anonymous – in name and location, says Wesolowski. Only if someone meets the imminent risk protocol, which the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates is only 2 percent of contacts to 988, will they try to locate that individual to send life-saving services, says Wesolowski. Half of that 2 percent share their location willingly, she adds.
While Scott is not convinced that 988 is a “resource where you could feel safe talking without there being ramifications,” Basinger says the conversations she’s had with the trained counselors have saved her dozens of times.
Basinger says that after multiple failed visits to an ER in Cincinnati in 2022 when she was feeling actively suicidal, “the most desperate that I’ve ever felt in my entire life,” she says, she called 988. “There’s a power in talking to a stranger,” she says of the 50 calls to 988 she estimates she made over the course of nine months that year. “I would contact them when I was suicidal. I would contact them when I was not suicidal, but in crisis,” she says. “They weren’t friends, they weren’t family, they weren’t part of my care team. It was just, it was freeing, honestly.” Studies show that like for Basinger, speaking with a crisis counselor helps callers feel more hopeful and less depressed and suicidal.
Still, there are 21st-century issues that never plagued 911 when it first rolled out in 1968. Geolocation is one of them and may have been an issue for Jessica when she called 988 from New York City using a cell phone with a Washington, D.C., area code to report a concern about someone in Virginia. It’s an issue that NAMI has been pushing Health and Human Services (HHS) to fix for years, says Wesolowski of a system she calls “a work in progress.” She expects new georouting technology to launch this year enabling calls and texts to be routed based on physical location, not area code, while still blocking the individual’s location.
But Jessica. believes her bad experience wasn’t just about technology. When her friend called, she was looking for someone to help her – and him. “[He] called me, basically, saying goodbye, telling me he didn’t want to be alive anymore,” she says. They’d worked together during summers in college and hadn’t for a while. While she knew he’d stopped drinking years ago, she could hear a slur in his speech. When her mother suggested she call 988, “I was expecting someone to help me and to walk me through what to do,” she says.
Instead, they sounded like they were “simply reading from a transcript. No sympathy, no warmth, no, ‘You’re doing the right thing, we’re going to help you.’ I felt questioned, almost like they were checking to see if I was being honest,” she says. When she told them she didn’t have her friend’s address, the counselor told her to call 911, a recommendation that shocked her. “You want someone with a gun on them to show up at his house when he’s having a mental health crisis?” she recalls asking the 988 counselor.
She hung up and called back two more times while also juggling phone calls and texts to check on her friend, “and they kept just telling me to call 911.” Finally, she enlisted the help of her brother who reached out to a friend – a former social worker. He found the number for Virginia’s Emergency Mental Health Services, CR2 Crisis Response. “The person who answered was the opposite of the people on 988,” says Jessica. “I felt that I could trust him.”
In the end, “it took me talking to my mother, my brother, my brother’s friend and three separate calls to 988 and social [media] to find someone who could actually help my friend,” says Jessica. DM’ing mutual contacts on Instagram, she tracked down his parents’ phone number. Eight hours after the whole ordeal began, it was the police who ended up at her friend’s home. The crisis counselor assured her that the officer they were sending was trained in mental health response but was not a mental health officer, apologizing for the fact that there just weren’t enough mental health professionals available to match the need. When they knocked on her friend’s door, the police had his parents on speaker phone.
“988 is only a piece of a crisis system. You need mental-health-related, in-person response. You need places for people to go when they need it. And so we’ve been focused on advocating for that full continuum of crisis care that treats people humanely and gives them the care that they need,” says Wesolowski. “We can’t rest until everyone is getting the support that they need.”
