What the 988 Lifeline is and How It Works
The 988 Lifeline, like 911, is a national number which will connect you to a call center to help you connect with emergency assistance 24 hours a day 7 days a week, 365 days a year. It is not a singular place or organization, but a national collective of local entities taking and responding to calls in their local communities.
The 988 Lifeline runs through the existing national suicide prevention lifeline and expanded infrastructure the under the supervision of the Substance Abuse and Mental Health Services Administration (SAMHSA) on the national level.
SAMHSA then contracts with local entities to create 988 call centers which will respond to calls and connect people to local support as needed. In the event that the nearest local call center is unavailable, calls are routed to the next closest available call center to ensure that calls are answered in a timely manner. Individuals needing help are also able to reach the 988 Lifeline via text message and online chat.
Once connected to a crisis counselor, a person will be able to talk through their issue, ask for assistance and get referrals for local resources. Call center workers and counselors are responsible for assessing, de-escalating and connecting callers to additional assistance and various resources depending on the situation and needs of the callers. Like with 911, the crisis counselor will likely request the name, contact information, and location of the caller.
Why the Change to 988?
The COVID-19 pandemic exacerbated the existing mental health crises which were already in epidemic proportions in the United States. One issue which gained support even before the COVID-19 pandemic was the need to reform the system of how people in crisis are able to reach out for help. So in August of 2019, the Federal Communications Commission (FCC) proposed a new 3 digit code for easier access to mental health and substance use support.
In July of 2020 the FCC and Congress authorized the use of the three digit code, 988, for mental health, substance use, and suicide crises.The new code uses and expands what was previously called the National Suicide Prevention Lifeline. Advocates also wanted to use the code to remove the direct connection to suicide prevention in the national line’s name to help people understand that the hotline is a resource for other emergent issues and not only for suicidality.
Two years later on July 16th, 2022 the 988 Lifeline became active nationwide with the purpose of making support for suicide and mental health crises more accessible, streamlined, efficient and effective. In December of 2022, additional funding was allocated for the 988 Lifeline to increase care for lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ+) youth. This money was dedicated to improve training for hotline counselors and to provide specialized resources to marginalized youth.
The Ups and Downs of The 988 Lifeline
The 988 Lifeline had a rocky rollout with states being underprepared and long wait times to be connected. These issues were both because localities did not have adequate infrastructure and the ease of the new number resulted in massive increases in calls – a 263% increase in answered calls and a reported 1,445% increase in texts. This means that more people are getting assistance. Additionally, the time it takes for a call to be answered drastically decreased with time. Further funding has already been allocated to increase access and address specialized needs of minoritized communities, particularly, LGBTQIA+ youth. Depending on location, there are also many towns, counties, and states which are increasing support and funding for needed services and non-police response teams.
While the 988 Lifeline has been successful in efficiently connecting more people to its crisis line services, several issues have persisted, particularly police involvement, the use of involuntary hospitalization, and lack of availability of follow-up care and resources.
For years, mental health advocates have been concerned with armed police response being the standard for mental health crises, as those in active mental health crises are sixteen times more likely to be killed by the police, especially those of marginalized racial identities. Despite mental health calls representing at least twenty percent of their calls, police departments often do not require adequate training on how to non-violently respond. US police training tends to focus more on threats and the escalation of force, and US police training tends to require notably fewer initial hours overall, when compared to many other Western countries.
Beyond the increased risk of death due to armed response to mental health crises, activists and mental health professionals alike have been concerned and frustrated that even non-police responders default to involuntary hospitalization for those in crisis. Those who have been subject to involuntary hospitalization from a crisis call point out that the process can be traumatic, cost them jobs and housing, all of which exacerbate their mental health symptoms and result in them being less likely to reach out for help in the future.
Despite the drawbacks above, other activists, officials and professionals believe that the Lifeline’s ability to help more people outweighs the issues of access, staffing, quality of care, and lack of funding which broadly extend to all mental health and substance use care in the United States. While these issues need to be addressed, the belief is that 988 is one step in the right direction to provide much needed care now, even if imperfect.
What Can You Do?
While the 988 Lifeline has issues which need to be addressed, that does not mean that it is useless, nor that people should ignore the resources available to them. When calling 988, like with 911, a caller is mostly in control of what information they provide.
When calling for yourself, don’t be afraid to express what is happening for you and what you are requesting. The Lifeline recommends that – as the call progresses – say no if a resource is offered that does not meet your needs. Additionally, be honest if you need to hang-up or end the chat.
The Lifeline also recommends that if you are calling for someone else, have their name, location, and reason why you are calling ready. It can help to write it down before. When possible talk with the person you are calling for before you call.
Before a crisis, talking with the people in your life whom you trust about what kinds of support can help to create mutual communities of support. Having these supportive networks where you feel able to express yourself, can help to prevent or respond to crises. Consider taking a Mental Health First Aid (MHFA) course and encouraging your friends, family, and other community members to do the same. MHFA can help to decrease stigma around talking about mental health and substance use and allows people to feel confident in engaging in said conversations.
There are additional resources available across the country if you feel that you need to talk, but feel like a crisis line is too much. Warmlines (click here for a directory) are hotlines run by people with lived mental health and/or substance use experience who are trained to talk with people who need a listening ear. However, unlike the 988 Lifeline, not all states have warmlines which function 24/7, though some state warmlines are open to out of state callers.
If you are still concerned about using the 988 Lifeline, organizations, like Fireweed Collective, provide resources, including videos, groups, and webinars to help people understand their mental health and create communities of care and mutual aid.
While The 988 Lifeline can be a positive and powerful resource, work needs to continue to address mental health and substance use in the United States. So consider staying informed of local, state and federal legislation and policies which improve access to both crisis and ongoing care for mental health and substance.
This article is not a substitute for medical advice or professional counseling. While we at Take This want to provide you with resources, we do not recommend or endorse any particular site, treatment, therapy, or resource. We provide these links at our sole discretion but have not necessarily vetted or reviewed any particular resource. We assume no liability for the use of the information or resources on these sites and encourage you to use your own best judgment when reviewing these resources.
If you live in the US and you’re having suicidal thoughts, reach out to the Suicide & Crisis Lifeline or call/text 988. If you’re outside the US, you can find local crisis lines at Suicide.org. If you’re even debating whether you should call them, you should call them. The Suicide & Crisis Lifeline handles all psychological crises, not just suicide.
Cassie Walker (they/them) is a clinical social worker and trauma specialist. They currently specializes in activist and clinical work with people who have intersecting identities, including Black, Indigenous, and other People of Color, those identifying as part of the LGBTQIA+ communities, people who practice kink/BDSM, non-monogamy, and those who follow Pagan and/or African Traditional Religions and spiritualities. Cassie teaches and presents on decolonial and liberatory praxis and theory in various aspects of life and society including, mental wellness, healthcare, gaming, and business. They earned their Bachelor’s in Psychology and Comparative Human Development from The University of Chicago and their Master of Social Work from University of Illinois at Chicago. They also have a background in developmental psychology and mental/behavioral health research. In their free time, Cassie cooks, bikes, plays tabletop role playing games, makes costumes, and watches cooking shows with their two cats.
Cassie can be found on Twitter.