The 988 Hotline: How Is It Working?

The 988 hotline, designed to be like the 911 connections to emergency services, has been in operation now for a couple of months. What have been the reactions to it so far?

Well, the number is shorter than the ten-digit former one for the National Suicide Prevention Lifeline (now known as the 988 Suicide & Crisis Lifeline); is for people experiencing any emotional distress, not solely a suicidal crisis; and can be reached via phone, text, or message app. A trained crisis worker in a center close to the caller will listen and then provide information about support and resources available in the area.

All that sounds — and is — laudable. Even so, the hotline’s existence has not been universally applauded. What are some of the perceived or reported problems?

Back when the hotline was still the National Suicide Prevention Lifeline, there were difficulties with wait times before speaking to a therapist. Many people who were on hold hung up. There is little reason to believe that this problem will go away — in Illinois, it’s been reported that 30% of callers hung up before reaching a counselor. The same company that ran the former hotline, Vibrant Emotional Health, is running the new hotline. And with all the publicity around the new number, there may be an even greater number of calls. (This might be optimistic, though, since a recent survey said over 75% of Americans had not heard of it by the end of June, just before the hotline went live. Federal funding may allow them to hire more of those trained crisis workers, but will that be enough?

That federal funding is another problem. Much is left up to the states, and there are a number that are not cooperating, neither funding nor publicizing the hotline. Only 20 states have done so. And let’s do the math. The federal funding totals $432 million, far more than was formerly spent on the mental health hotline, but it still means only an average of $8.6 million for each state. States can tap additional funding through sources including Medicare and opioid crisis money. But the lack of state involvement will certainly hinder the counselors in finding and recommending resources close to the callers — and callers in rural areas, for example, may not have any resources close by.

Another major concern that has gotten a lot of pushback from the mental health community — especially expressed on social media such as Twitter and Instagram (hundreds of thousands responded with likes) — is who will respond to calls that require serious intervention. Many are afraid that the local police will be notified of a suicidal person or other mental health crisis and respond to it with the aid of a crisis response team.

Specifically, they are upset because of the number of deaths that result when police who do not understand mental illness and its symptoms get involved. The officials that run the hotline say that police or EMTs are called only as a last resort effort for suicide situations. But many potential users are skeptical.

There have been rumors that the hotline can collect geolocation information about callers, but this seems to be limited to general location by phone number and area code, or IP address, which may be helpful in putting callers in touch with local resources, but also means that law enforcement can have this information if the hotline counselors do contact emergency services. Counselors are scheduled to receive training on when to call in law enforcement personnel and the dangers of it.

Of course, not all police involvement results in death. But there are other concerns when police and EMTs are involved. Among these are people being taken to hospital emergency rooms, where they receive slow or inadequate treatment, and involuntary treatment in psychiatric hospitals. (This is a particular concern for people in the LGBTQ+ and POC communities.) When there are so few options to treat the seriously mentally ill, the likelihood of the counselors providing useful advice for sufferers or families is not great.

Nonetheless, we should not let these potential problems overshadow all the good that the new 988 hotline will do. The more coordinated effort with the easily remembered number will help those who know about it in times of crisis. When the bugs are worked out, the states get on board, and the public becomes more aware of the service, it should prove a valuable resource for those not just with suicidal thoughts, but with everyone who suffers from a mental illness and who needs a listening ear, counseling, and resources.

Of course, no new public service endeavor gets off the ground without some rocky start-up time and a few glitches. Let’s keep an eye on the new hotline and see what it can do once it shakes out a bit.