Three little numbers are playing an outsize role in preventing people from taking their own lives: 988, the nationwide Suicide and Crisis Lifeline phone number.
Since its launch in 2022, the service has received more than 10 million contacts from those in need of vital and timely assistance for a mental health crisis.
“We know there’s a need for effective mental health crisis response, and 988 can be a big part of how we intervene and save lives,” Stephanie Pasternak, director of state affairs for the National Alliance on Mental Illness, or NAMI, told a session at NCSL’s 2024 Base Camp.
“For the overwhelming majority of people, the crisis call center is the intervention, meaning that most people do not need any of the in-person services.”
—Stephanie Pasternak, National Alliance on Mental Illness
NCSL Policy Analyst Molly Widoff offered sobering statistics supporting the need for the hotline, which was created by Congress in the National Suicide Hotline Designation Act of 2020. According to the Centers for Disease Control and Prevention, nearly 49,000 people died by suicide in 2022, making it the second-leading cause of death among people ages 10-34. Overall, white males accounted for nearly 70% of those deaths.
Suicide rates for men and women steadily increased from 2001 to 2021. The death rate for males was three to four times the rate for females, though females were more likely to attempt suicide. The death rate was highest in women ages 45-64; for men, it was age 75 and above.
Rural areas experienced the highest suicide rates, with Montana, Alaska, Wyoming, New Mexico and North Dakota at the top of the list. The lowest rates were in Washington, D.C., New Jersey, Massachusetts, New York and Maryland.
The CDC recommends several actions to help reduce suicide risk, Widoff says, including improved access to suicide care and mental health services and healthy connections to combat social isolation.
The call line supports those initiatives, Pasternak says.
“At NAMI, we have a saying: 988 is more than a number. It’s a whole system,” she says.
Pasternak says the system is centered on three pillars of service:
- Someone to talk to.
- Someone to respond.
- A safe place for help.
When someone dials 988, the call is routed to the nearest call center. Callers hear automated prompts that guide them to numbers corresponding to their identities, such as military veterans, LGBTQ+ individuals or those who speak Spanish or other languages; or they simply are connected to a counselor. There is videophone service for the deaf.
If a call is not picked up within two minutes, it is routed to a national backup center to ensure no call goes unanswered.
As of last year, Spanish speakers made 90,000 calls and sent 20,000 chats and texts to 988, according to the U.S. Health and Human Services Department. LGBTQ+ youth have dialed nearly 500,000 times since last year.
The system is free, confidential and staffed 24/7 by counselors trained to respond to a variety of behavioral health crises, Pasternak says. They can coordinate services and dispatch mobile crisis teams of mental health professionals and peer support pros.
“They can come to wherever you are … and de-escalate the situation,” Pasternak says, but “for the overwhelming majority of people, the crisis call center is the intervention, meaning that most people do not need any of the in-person services. Anywhere between 80% to 95% of calls are completely handled with the call itself.”
Though the system was created at the federal level, it is implemented by state and local agencies. It is funded by a fee added to cellphone bills in the range of 8 cents to 60 cents per month; it is like fees for 911 emergency service lines that range from $1 to $5 per month across the country. The phone fee provides a sustainable revenue source, insulated from the ebbs and flows of state tax revenue and unpredictable budget cuts, Pasternak notes.
So far, it has a limited reach.
Ten states have passed legislation that allow cellphone carriers to add a monthly fee: California, Colorado, Delaware, Maryland, Minnesota, Nevada, Oregon, Vermont, Virginia and Washington. But Pasternak is optimistic about the future: Nine states have passed study bills that can help shape enabling legislation in the future.
Another big need is to raise awareness about the service. A poll commissioned by NAMI earlier this year found that only 23% of Americans say that they are familiar with 988.
One of the primary ways states are raising awareness, especially with the key demographic of younger people, is by requiring 988 on student ID cards. In 2023, at least seven states passed legislation to require the 988 student ID notice, Pasternak says.
Call rates to 988 have been increasing, “which really means that more people than ever are being helped and are connecting to support more quickly,” Pasternak says.
Brian Weber is a Denver-based freelance writer.