In July 2022, we reported on the impending launch of the 988 Suicide & Crisis Lifeline. In this report, we follow up on what has happened since then.
The federal government-backed 988 Suicide & Crisis Lifeline launched about 18 months ago with much fanfare; the Biden administration hoped it would garner more calls than the cumbersome 10-digit number that had been in use previously.
“The importance of our work to launch the ‘988’ lifeline cannot be overstated,” HHS Secretary Xavier Becerra said on a phone call with reporters in December 2021 during a “preview” of the new number. “Every 11 minutes an American dies from suicide. Too many Americans are experiencing mental health crises without the support and care they need. In 2019 alone, suicide was the second leading cause of death among young people and was the 10th leading cause of death in the nation. One of every 20 Americans [ages] 18 and older had serious thoughts of suicide, and one in 200 attempted it.”
Generally Positive Reviews
The lifeline routes callers to a network of more than 200 state and local call centers that are financially supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), as well as state and local governments. In its first year, according to a July press release from SAMHSA, the lifeline answered nearly 5 million calls, texts, and chats from people looking for help with suicide, mental health, and substance use-related crises; that’s 2 million more contacts than the lifeline received in the previous 12 months, when it was a 10-digit phone number. (That 10-digit number — 800-273-8255 — is still in operation.)
So far, 1.5 years in, things seem to be going well overall, said Michele Gilbert, MPH, senior policy analyst at the Bipartisan Policy Center in Washington, D.C. “Luckily, the implementation of 988 has seen some real success,” Gilbert said in a phone interview. “A lot of the operations have gone relatively smoothly.”
Debbie Plotnick, MSS, executive vice president for state and federal advocacy for Mental Health America, agreed. “We have seen tremendous increases in the number of people who call, and even more importantly, what has improved dramatically is the wait time to speak to an actual human being,” she told MedPage Today. “Going back a couple of years, it could have been up to, like, 2 minutes, and now it’s within 30 or 40 seconds that you are actually connected to a live human being.”
That decrease in wait time may not sound like a lot, but it’s actually “huge,” Plotnick said. “If you’re at the point where you’re going to hurt yourself and you don’t know if anybody in the world cares, 2 minutes can really feel like an eternity. But now calls are being answered very quickly.” She also praised the lifeline’s addition of text and chat options, as well as special lines for veterans, for Spanish speakers, and for LGBTQ+ callers.
Concerns With Routing Calls
In addition to the successes, however, there are a few issues the lifeline struggles with. One has to do with routing callers to the closest call center, which becomes important in cases where the caller needs to access local resources such as a therapist or a mobile crisis team. Currently, the caller’s phone number is used for routing, which doesn’t work well if the caller has a phone number linked to where they previously lived (for example, if they moved from Los Angeles to Boston, but they bought their phone in Los Angeles and it has a Los Angeles area code and 7-digit number).
For 911 calls, emergency officials use a geolocation system to pinpoint a caller’s exact location. But due to privacy concerns, geolocation is not suitable for the 988 lifeline, mental health experts say — some callers may not want to reveal their exact location to someone at a call center. Instead, what is being recommended is “georouting,” a routing method that directs the caller to a 988 crisis call center based on cell tower location and wire-center boundaries, but does not reveal a caller’s exact location, according to SAMHSA.
“It’s really important to fix that when you’re talking about 988, so that when you talk to the crisis person who’s answering the phone, they can send you to services that are in your location,” said Plotnick. “They can tell you about resources that exist in your community” or — in the small percentage of cases in which it’s necessary — send a mobile crisis team to the caller’s location.
The Federal Communications Commission (FCC) seems to agree. “Getting help got a lot easier when we implemented 988 as the easy-to-remember, 3-digit number for the 988 Suicide and Crisis Lifeline,” FCC chairwoman Jessica Rosenworcel said in a September 28 press release. “But more can be done to ensure those in need can reach local resources for mental health support. We need industry’s help to improve access to this lifesaving service that the 988 Lifeline provides while being respectful of the privacy and confidentiality of callers reaching out for support.”
The same day, Rosenworcel and Miriam Delphin-Rittmon, PhD, assistant secretary for mental health and substance abuse at HHS, also sent joint letters to all the major wireless carriers as well as to CTIA, the telecom industry association, asking them to work on the issue.
“We strongly encourage you, as a leading wireless carrier, to take the necessary steps to identify and develop a 988 georouting solution that could be deployed in your wireless network within a reasonable time,” the letter to the wireless carriers said. “This is a surmountable technical challenge, and we hope you will take this opportunity to work toward georouting implementation that will both benefit your customers and be efficient for the operation of your network.”
Some members of Congress also are interested in solving this problem. Senators Alex Padilla (D-Calif.) and Thom Tillis (R-N.C.) — co-founders of the Senate Mental Health Caucus — introduced the Local 9-8-8 Response Act on December 7. This measure would require the FCC to “initiate the rulemaking process for regulations to ensure that each phone call, text message, and chat made or sent from a provider of commercial mobile service to 988 is geographically routed by the provider to the termination point designated by the participating crisis center that is responsible for the geographic location from which the phone call, text message, or chat originated.”
The bill would give the FCC 6 months to issue final regulations and also requires the agency to “ensure that the geographic location used to route the 988 call, text message, or chat is accurate enough to determine the proper participating crisis center without revealing the precise location of the individual who made or sent the phone call, text message, or chat.” A companion bill was introduced in the House by Rep. Tony Cárdenas (D-Calif.).
“Congress created the bipartisan 988 hotline to make it as easy as possible for Californians and Americans in crisis to quickly access lifesaving support,” Sen. Padilla said in a press release. “Mental health response on the lifeline must be efficient and safe, but the current system risks connecting callers to response teams thousands of miles away. We need to improve access to the hotline and connect callers with their nearest center for support.”
Hiring Staff Is an Issue
Finding enough people to staff the call centers is another problem. At a July 2022 mental health summit in Washington, D.C., Emily Blomme, CEO of Foundation 2 Crisis Services, a crisis prevention and intervention service in Cedar Rapids, Iowa, noted that the pay she could offer to prospective employees of the organization’s 988 call center was low, largely because much of the funding for call centers was left to each individual state. Out of the 25 people Blomme needed to staff her crisis hotline, she had hired only 10.
“Pay starts at $17.50 an hour; I’m competing with places like Target,” she said at the event, which was sponsored by the Alliance for Health Policy. “I lost an employee to AirFX, which is a trampoline park … Being a cashier is much easier than answering crisis calls. My teams work 8, 10, 12-hour shifts and they never know what’s on the other end of the line when they pick it up. The dilemma is, what do I pay someone that saves lives for a living? What is that worth per hour? The answer is that I don’t have enough money to pay people what they’re worth.”
“Workforce is an issue throughout the entire array of mental health services and supports,” said Plotnick. “That’s one of the things that the advocacy community works on is making sure that people have livable wages, and wages that are competitive. So it’s an ongoing issue that is being addressed.” She noted that several states have passed bills that add a small fee — usually from 30 to 60 cents — onto everyone’s monthly cell phone bills to help fund the 988 service.