New Law Establishes 988 As National Suicide Hotline

Last week, President Trump signed a law that will create a mental health emergency hotline at the number 988. The hotline will become active in 2022, and will replace 1-800-273-8255 (TALK), which is the current National Suicide Prevention Lifeline.

Some experts say the change will help reach more people, as calls to emotional support hotlines have increased in recent years, particularly during the pandemic. Others are wary it will place additional stress on crisis centers that are already overwhelmed and underfunded.

Expanding The Lifeline Could Save Lives

Having a crisis line that's only three digits is important, simply because it will be easier to remember, says Leela Magavi, MD, regional medical director of Community Psychiatry. Often, people experiencing anxiety or depression have problems with working memory and processing, she says.

"People have access to the hotline numbers and crisis numbers, but they're very long numbers," Magavi says. "So 988 will be very easy for individuals and their loved ones to remember, so we can save lives."

988 will also put callers in touch with mental health professionals, which will keep them safer, says Jonathan Singer, PhD, president of the American Association of Suicidology.

"Right now, the end of every therapist's outgoing message is, 'If this is a crisis, please call 911,'" Singer says. "It sets up a situation where mental health emergencies are responded to by law enforcement."

That situation could become dangerous or even deadly for Black people, transgender people, or people with autism.

Magavi says that she has patients with autism who have struggled with insomnia, depression, and anxiety due to interactions with police. "I think 988 will alleviate that anxiety to initiate and make that step to call for help," Magavi says.

"A lot of people do not call 911 because... they're scared about what might happen, if their loved one will be handcuffed or be traumatized," Magavi says. Negative interactions with police can even lead to an increased risk for suicide, she says.

Crisis Centers Are Critically Underfunded

Currently, there are about 170 local crisis centers in the Lifeline's network, NPR reports. When someone calls in, they are routed to the center that's closest to them.

But a lack of federal funding means those centers are already stretched thin. Some have even shut down or left the network. PBS reports found that from 2008 to 2012, nine centers dropped out of the network. From 2013 to 2017, 23 dropped out.

The new law will allow states to collect fees from mobile service providers and use the funds to support 988, though it's unclear how much more funding the fees will generate.

"On its face, 988 looks great," says Dese'Rae L. Stage, a suicide attempt survivor and creator of "Live Through This," a multimedia documentary series that tells the stories of other suicide attempt survivors. "The reality is that people who are answering crisis calls and the centers that they're in are not staffed appropriately."

Stage recalls when the rapper Logic, an advocate for suicide prevention, performed the song "1-800-273-8255" at the 2017 MTV Video Music Awards. That night, the National Suicide Prevention Lifeline's call volume increased by 50%.

While increased awareness is ultimately a good thing, she notes that a sudden spike in calls like that may result in longer wait times if the lines are understaffed. "That's not a great experience for someone who's experiencing a crisis—to be put on hold," Stage says. "That's a problem: more volume, not enough staff, not enough staff getting paid well."

Singer says he hopes the new law to create 988 will emphasize the need for additional funding. "My hope is that it will provide incentives for communities to think about how they're allocating funding, so that crisis services actually get the funding that they deserve and that they should have in order to respond to the needs of the community," he says.

A Larger Broken System

Even if crisis centers were to receive more funding, Stage says there are other systemic problems with how the Lifeline operates and the ways we talk about suicide in the United States.

For example, the Lifeline allows counselors to call emergency services for an "active rescue" without a caller's consent when they believe the caller is at "imminent risk of suicide." It's a policy that Stage says can result in a "scary and humiliating and degrading" experience.

When Stage attempted suicide, someone she knew called police. They showed up at her apartment and told her she was going to the hospital. "And I said, 'OK, can I put on a bra?,'" Stage recalls. But they wouldn't let her. "I'm scared and I want to die and I'm out in public with no bra," Stage says. "And that might seem like a little thing, but it's just something that stuck with me... It's kind of dehumanizing."

Stage says that experts also often rush to blame mental health for suicidality, though the Centers for Disease Control and Prevention found in 2015 that more than half of people who died by suicide did not have a known diagnosed mental health condition at the time of death. "Relationship problems or loss, substance misuse; physical health problems; and job, money, legal or housing stress often contributed to risk for suicide," the CDC wrote.

When you call the Lifeline, Stage says, they'll often tell you to go see a therapist or practice self-care. "It's always around mental health," she says. "It's not... 'how can I help you through the application process for services like WIC, ... [or] how can I help you find housing?' It's about your mental health."

The coronavirus pandemic complicates the creation of 988 even more. The line won't be available until 2022, but Magavi says there is definitely a need now.

In late June 2020, the CDC surveyed more than 5,000 adults about their mental health. It found that nearly 10.7% of respondents said they'd seriously considered suicide in the last month. That's more than twice the rate from 2018, which was 4.3%.

But Stage notes that the "widespread sense of despair" brought on by the pandemic is the result of a variety of factors: the police killings of unarmed Black people, protests in response to those killings, job loss, and COVID-caused or -related deaths.

"COVID has given us a really clear window into suicide not just being linked to mental health, unless you're considering a response to COVID a mental illness," Stage says. She hopes that in addition to creating 988, the suicide prevention field will put together comprehensive resources that will help address social determinants of health, like economic stability and healthcare.

988 will at least do a few important things, Singer hopes: It will bring attention to the various factors included in mental health support, and it will make calling law enforcement a last resort.

"I'm not saying that the mental health system as currently organized is necessarily a better alternative, but what'll happen is that it'll start with mental health," he says.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.