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988: The New Mental Health Crisis Hotline, Explained

What to Consider Before Calling 988, the New Mental Health Crisis Hotline

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988 is the nation's new mental health-specific crisis hotline — and it seems to be working. There has been a 45-percent increase in overall contact volume compared to August 2021, according to recent data from the US Department of Health and Human Services (HHS).

"In August 2022, the 988 Lifeline answered 152,000 more contacts (calls, chats and texts) compared to August 2021 and significantly improved how quickly contacts were answered. The average speed to answer across all contacts decreased from 2.5 minutes to 42 seconds," per HHS.

The hotline is meant to serve as an immediate resource for people experiencing mental health emergencies like suicide ideation, addiction, panic attacks, and more. Considering the fact that more than 12 million people had serious thoughts of suicide and one in 20 adults experienced a serious mental illness in 2020, per the National Alliance on Mental Illness (NAMI), it's clear that people don't just need more mental health resources — they also need alternatives to 911, which can result in police involvement or law enforcement dispatched to your home.

"We believe strongly that people who are in a mental health crisis deserve a mental health response, not a criminal justice response," says Jennifer Snow, national director of government relations, policy, and advocacy at NAMI.

A survey conducted by NAMI found that 46 percent of people would not feel safe calling 911 for help if their loved ones were experiencing a mental health or suicide crisis. The reason is likely in part because interactions between the police and those with mental illness have been dangerous and at times deadly. In fact, per NAMI, one in four fatal police shootings between 2015 and 2020 involved a person with a mental illness, and those with mental illness who do survive police response run the risk of jail or prison time. (For context, two million people with mental illness end up in the nation's jails every year.)

"Our nation's transition to 988 moves us closer to better serving the crisis care needs of people across America," HHS Secretary Xavier Becerra said in a statement.

But some people are worried that 988 may not be safe enough. Liz Winston, a peer support coach specializing in helping people leave the mental health system, posted on Instagram that "988 is not friendly" and called on people not to post about or recommend the hotline without considering the risks of police involvement, involuntary treatment, and medical debt, among other factors.

Winston's cautionary approach isn't unfounded. One report published in the Harvard Review of Psychiatry found that suicide deaths and attempts increase drastically after being released from psychiatric hospitalization. Additionally, one review found that in 2014, "24 states — accounting for 51.9% of the U.S. population —recorded 591,402 emergency involuntary detentions, a crude rate of 357 per 100,000 persons." And instances of forced psychiatric care, people who don't even want treatment are left with hefty bills at the time of their release. But that's not to say that people can't benefit from using the service. Here's what you should consider before dialing 988.

Who Are You Dialing When You Call 988?

As of July 16, when you dial 988 from anywhere in the country, callers are routed to the National Suicide Prevention Lifeline. The previous number for the lifeline (1-800-273-TALK) has been redirected to 988, making it easier to reach the services you need. On the other end of the phone, you will first hear a greeting message, and then you'll be directed to a crisis counselor at a local call center based on your area code, Collins explains. If for some reason the call center does not have the capacity to take your call, you will be directed to the national backup center.

Each center is independently operated, but most centers employ a mix of staff and volunteers. "All centers train all of their call takers, with an average of 90 hours of training," Collins says. The Lifeline also provides several tools and resources to support the call takers, including a safety assessment site, webinars, and a number of guidance documents and tip sheets.

Will Someone Be Dispatched to Your Home or Current Location?

Sometimes. "The goal is that people who call 988 get the help that they need, and in most cases, that means being deescalated over the phone," Snow explains. Crisis counselors will also connect callers with follow-up services and resources. A 2019 analysis of the crisis system in Tucson, AZ, from Arizona Complete Health showed that 80 percent of crisis-line calls were resolved without dispatching mobile crisis team, law enforcement, or emergency medical services. But if you need in-person help, the type of dispatch you receive will depend on whether there is a mobile crisis unit available in your area. Those working on mobile crisis teams are behavioral health professionals (i.e., social workers, peer specialists, and family peer advocates). If a mobile crisis center is unavailable in your area, it may fall on 988 to send police response. Eventually, the goal is to be nationally equipped to dispatch specially trained responders to your crisis location.

There has been congressional legislation to give states the money to expand these mobile crisis teams, Snow says. And President Biden's Fiscal Year 2023 budget requests $700 million for crisis center and crisis response expansion, "so people experiencing a behavioral health crisis have a place to call and a place to go," according to a recent White House statement.

Does It Cost You Anything to Call 988?

No. "It will never cost anybody to call the lifeline," Snow says. But in terms of how the resource is funded, it's a combination of federal, state, and local funds. On the federal level, there is legislation that allows states to tack on a user fee for 988 to phone bills, similar to the one you automatically pay for 911. But you will never be charged for calling the lifeline itself.

Are there options other than 988?

If you feel concerned about calling 988, but need assistance and support, there are other call lines available.

  • Blackline offers immediate crisis counseling for Black, Brown Indigenous, and LGBTQ+ people.
  • Trans Lifeline is a peer support phone service run by trans people for trans and questioning people. The site guarantees full confidentiality and no nonconsensual active rescue, including 911, emergency services, or law enforcement
  • Wildflower Alliance offers peer support, trauma-informed call lines as well as alternative healing practices, housing support, and consultations.

- Additional reporting by Sara Youngblood Gregory

Image Source: Getty / Sarah Mason
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