The 988 Suicide & Crisis Lifeline added Spanish text and chat services ahead of the hotline’s one-year anniversary on Sunday.
Specialized services for LGBTQ+ youth and young adults were also added earlier this month after a successful pilot that found the population accounted for 6% of calls, 11% of chats and 15% of texts. Later this year, the hotline plans to add video phone service to better serve deaf and hard-of-hearing individuals, per an announcement.
The hotline transitioned to three digits last year. Since then, it has answered nearly 5 million calls, texts and chats, 2 million more than was received in the previous 12 months. Almost 1 million of the calls were answered by the Veterans Crisis Line, which 988 links to.
In 2021, suicide was the second-leading cause of death for people aged 10-14 and 25-34 years old. About 12.3 million adults and 3.3 million adolescents had serious thoughts of suicide that year.
“We are facing a behavioral health crisis in this country. With our continued investment in 988, and the addition of Spanish language text and chat services, we are furthering our commitment to addressing this crisis head-on,” Deputy Secretary Andrea Palm said in a press release.
'One of the most important decisions in mental health in decades'
Compared to the 12 months before the launch, texts through the hotline increased by 1,135%, chats answered increased by 141% and calls answered increased by 46%, according to data from the Department of Health and Human Services (HHS) released publicly. The average speed to answer contacts decreased from 2 minutes and 39 seconds to 41 seconds.
Robert Gebbia, CEO of the American Foundation for Suicide Prevention (AFSP), suspects that the new hotline is reaching a younger demographic because they are more likely to text, he told Fierce Healthcare. The transition to 988 is “one of the most important decisions in mental health in decades,” he said.
The Biden-Harris administration has invested nearly $1 billion into the initiative. More than $200 million in 988 Lifeline grants will be awarded in late FY 2023 to support states, territories and tribes.
Challenges with privacy and crisis response
The volume of calls, texts and chats are projected to rise to 6 million this year and 9 million next year. “Since more people know about it, volume will go up,” Gebbia said. In anticipation of the spike, the AFSP is asking for $836 million in additional funding to support the lifeline. This would allow for more public awareness campaigns, improved training and support for local and backup centers, Gebbia said.
The 988 Lifeline is made up of a network of more than 200 state and local call centers. Initially, calls get routed to a local crisis center. If they’re unavailable, the call goes to a backup center. “They’re the safety net, they’re the catch-all,” Gebbia said.
An ongoing challenge with call routing, Gebbia acknowledged, is that it is currently based on a caller’s area code. If someone lives in a different place than their area code suggests, the call center would have to route the call elsewhere. The most targeted help can come from local resources.
“What we’d like to do as we continue to evolve is get you closer beyond just the area code,” Monica Johnson, director of the 988 & Behavioral Health Crisis Coordinating office at the SAMHSA told CNN. “So we are exploring ways in which we can look at routing opportunities that don’t just depend on your area code.”
Recent reporting by investigative outlet The Markup revealed that dozens of sites tied to 988 share sensitive visitor data to Facebook, a responsibility Gebbia believes falls on SAMHSA and Vibrant to address. “When someone calls, texts or chats, we want to make sure that people’s privacy is protected,” Gebbia said.
Earlier reporting, prior to the launch of 988, found that some suicide hotlines billed as confidential secretly traced calls and sent law enforcement to callers who were not an immediate threat to themselves or others. One caller, forced into a stretcher and taken to a hospital against her will, faced a $50,000 hospital bill upon discharge.
“If someone doesn’t need active rescue, the worst thing you can do is send it,” Gebbia said. Additional funding for the lifeline could also support mobile crisis units and crisis stabilization centers, a better alternative to hospitals for patients in crisis, he added. And it could fund more mental health counselors responding to people in crisis instead of law enforcement officers, who are often not trained on crisis response and incidents with law enforcement have been known to get violent.
The road ahead
Crisis counselors are in need of support, and call centers could do more to retain their staff, the National Alliance on Mental Illness’s chief advocacy officer told CNN. “We need to keep the people we have as well as get more into the workforce and taking care of their mental health and wellbeing is paramount,” she told the outlet. “They’re dealing with people on the worst days of their lives.”
The Bipartisan Policy Center, a think tank promoting bipartisanship, recommends that SAMHSA develop a communications strategy to help build trust in 988, which must be paired with assistance to states, particularly on how to finance with Medicaid and block grant dollars.
It also recommends the HHS expand the National Health Service Corps to include crisis care sites, which could help with staffing, and to build out recruitment partnerships and engage peer support specialists within the system.
Most American adults remain unfamiliar with or have never heard of the hotline, according to a recent poll. The Substance Abuse & Mental Health Services Administration (SAMHSA) and Vibrant Emotional Health, the nonprofit administrator and operator of the 988 lifeline, plan to launch an awareness campaign this fall, according to CNN.