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The national launch of the new 988 Suicide and Crisis Lifeline this weekend is welcome news, but this valuable resource requires much greater support if it is going to help meet the needs of the increasing number of people expected to use the service.

988 Hotline

Background on the 988 Mental Health Hotline

988 is the new phone number people can call, text or chat if they wish to speak with a trained crisis counselor at any time. It is intended to replace the current Lifeline phone number (800.273.8255), although this number will remain active. The 988 number was rolled out nationally on Saturday, July 16, 2022. In 2020, Congress designated the new 988 dialing code.

As a new website dedicated to the 988 Suicide and Crisis Lifeline notes, when people call, text, or chat 988, they will be connected to counselors who are part of the existing National Suicide Prevention Lifeline network. These counselors are trained to listen, understand how an individual's problems are affecting them, provide support and connect them to helpful resources. The 988 Lifeline is intended to be staffed 24 hours a day, 7 days a week in the United States through a network of more than 200 existing crisis centers.

988 is being funded in multiple ways. As a Substance Abuse and Mental Health Services Administration (SAMHSA) fact sheet notes, Congress provided the Department of Health and Human Services workforce funding through the American Rescue Plan, some of which will support the 988 workforce. At the state level, funding is expected to come from existing public/private sector funding streams, while the National Suicide Hotline Designation Act of 2020 allows states to enact new state telecommunication fees that can go to support 988 operations.

Concerns About the New Mental Health Hotline Number

The new 988 Suicide and Crisis Lifeline comes at an important time. Mental illness is on the rise, with one study coming out of the University of Alabama at Birmingham finding that in the first year of the COVID-19 pandemic (April 2020-April 2021), the prevalence of people with depression or anxiety symptoms in America increased from about 11% percent of people in 2019 to close to 40%. However, media reports indicate that the new Lifeline may experience a bumpy national rollout and could face short- and long-term challenges.

Among them:

  • One in six calls to the National Suicide Prevention Lifeline is currently ending without the caller reaching a counselor, reported the Wall Street Journal. This would seem to suggest that crisis centers are currently struggling to handle the existing call volume. The transition to 988 is likely to bring with it an increase in call volume since the number is easier to remember, which would likely further strain centers and counselors and lead to an increase in the number of callers failing to connect with a crisis counselor.
  • Numerous states have yet to enact legislation to implement and fund 988. A Politico report noted that Health and Human Services Secretary Xavier Becerra said more than half of the states were still sending a significant portion of their crisis calls to an out-of-state backup call center as of May 2022. NPR recently covered the state-level struggles.
  • The NPR report noted that numerous positions for crisis counselors and staff for mobile response units, listed on the SAMHSA website, remain unfilled.
  • Funding from the American Rescue Plan was significant: More than $280 million was split between strengthening and expanding the existing Lifeline network operations and telephone infrastructure and building up staffing across states' local crisis call centers. However, this federal funding will expire in just a few years, which prompted calls for Congress to allocate more federal funding. The good news is the recently passed Bipartisan Safer Communities Act allocated $150 million for the National Suicide Prevention Lifeline for the fiscal year 2022, but more funding is and will be needed. Members of Congress have introduced additional bills to remedy the funding gap and further assist in the implementation of the 988, including the 988 Implementation Act.
  • The transition to 988 is happening very quickly compared to the country's move to 911, reports Axios.

Proem's Perspective on the 988 Mental Health Hotline

Thomas Young - nView HealthDespite the acknowledged challenges facing the national rollout and some uncertainty about the future of 988, including funding and staffing, the transition is a positive development for the mental and behavioral health community, said Proem Chief Medical Officer and Founder Thomas Young, MD. The simpler number should improve access to counselors and help fill gaps in mental health crisis care. "It is critical for anyone in crisis to have another human being to listen and for that moment in time to have their 'back,'" Dr. Young said. "When we feel lost and alone, someone to point the way offers hope for going on."

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