A Look at 988 Since Launch—How It Started, How It's Going

On July 16th, 2022, the National Suicide Prevention Lifeline was changed to the 988 Suicide and Crisis Lifeline—just 3 easy to remember numbers—in an attempt to simplify access to lifesaving support and crisis services.

And just a few months post rollout it seems to be paying off. In early September the US Department of Health and Human Services (HHS) announced that, since the switch, they had seen a 45% increase in calls compared to the same month the previous year.

Mental health professionals say that this increase in calls and increase in access can give us some key insights into the evolving state of mental health care in America.

The Proven Effectiveness of Hotline Promotion

This isn’t the first time the hotline’s usage has spiked. In 2017 a song named after the hotline’s previous number, 1-800-273-8255, performed by chart-topping artists Logic, Alessia Cara, and Khalid, led to an increased call volume.

A 2021 analysis by an international group of researchers, published in the British Medical Journal, found that the associated spike in call volume also meant fewer suicides during the same period.

Willow Goldfarb, LMHC, was a supervisor of both 211 and the lifeline at a Florida United Way call center during that period. She says that the song did mean the line got a lot of curious callers, teenagers and the like, but it also did a lot to raise awareness.

For her, the shortening of the number and the increase in access means that more people can be connected to these services, particularly in rural areas or those who are low-income, but it’s also important to keep in mind the limitations of a hotline. 

“Thankfully NSPL [national suicide prevention hotline], no cost, right? We can talk to somebody, but there's also that lack of continuity of care with that. Somebody can call 10 times in a month and talk to a different person every time.”

Goldfarb, who now works as a lead clinician at Thriveworks sees tools like 988 as part of a broader spectrum of supports that can be facilitated at more than just the national level.

“We can do more to support grassroots efforts and community-based efforts that are creating and building communities, mutual aid efforts…and that is a huge and integral piece to suicide prevention, and cannot be overlooked when we're having these big discussions about national programs and things like that.”

Expanding Access and Cultural Competency

Speaking of the national level, current American Counseling Association president Dr. Kimberly N. Frazier, PhD, LPC, NCC, LMFT, says that she’s optimistic that the increase in the hotline’s use hints at a reduction in the societal barriers people face when looking to access urgent mental health care.

“My hope is it's saying that there is less stigma surrounding seeking out help because of the influx of calls.”

Frazier, who has worked throughout her career with children in underserved neighborhoods,  and specifically with the black community, says that one key area projects like 988 have to keep in mind is their level of cultural competency. 

“I think [with] tools like the hotline, you have to make sure whoever is on the hotline is trained to catch things that may be cultural pieces that are coming out when you have someone that is in crisis, because many times in marginalized communities specifically, again, it is not something that someone comes to someone outside of the community, much less outside of the family to discuss mental health or crisis of any sort.”

For Dr. Alison Stoner, PhD, the increased access that comes with a hotline where you can text, call, and be supported in multiple languages can be a key part of clients' support plan, especially if they live in an area with lower levels of support available than she has at her disposal as a senior clinical manager for Brightline in Massachusetts.

“Not all states are as lucky to have that sort of service and so 988 really steps in to be able to provide that skilled triage and assessment to determine the appropriate level of care, and then facilitate and connect with the right next steps for youth and family," says Stoner.

Stoner continues, "So I would say that it certainly is an important support even for youth that are in ongoing treatment for those moments when there is an escalation in need and a need for meeting someone, no matter what time it is, no matter what day it is, to be able to assess their safety.”

What Practitioners Can Learn

Goldfarb says that her work on the hotline prior to entering into private practice was key in reframing how she sees suicidal ideation and those in that form of crisis.

“I learned to get comfortable sitting in the dark with someone and exploring their environment with them, and providing that safe place to show somebody that they don't have to be alone with that. And for most people, that's enough. We rush too much in clinical practice to telling people that they have so much to live for, and everything's gonna be okay, rather than sitting with somebody and feeling that sadness with them, and helping them to normalize that in themselves, but find that strength to keep going, too.”

Frazier, who teaches at Louisiana State University, says that it’s beneficial for practitioners to understand 988 as both a tool in a tool box and as part of the web of support that can be provided to those in need.

“It's another point, another point in the triage, another opportunity to catch those people that are in crisis that may not be able to access the other services, or even know of the other services. Because again, when you're in crisis, you're not thinking of all these other possibilities, you’re just thinking ‘I'm in crisis, get me out of crisis,’ or it seems hopeless while you're in crisis.”