By Samuelle Voltaire, MSW, MPH

Back in 2017, I worked at the local 211 hotline for Central Florida. In addition to providing information and referrals to callers, we also answered the local mental health crisis line and the local calls from the national suicide prevention lifeline. Something shifted in the spring of 2017. More calls to the hotline. More conversations about mental health. But…why?  

Based on the email my colleagues and I received, two significant cultural events happened. In March 2017, Netflix released a series adaptation of the novel 13 Reasons Why. In April 2017, a rapper named Logic released his song “1-800-273-8255”. To clue you in, the title of this song is the former phone number of National Suicide Prevention Line (NSPL). For the first time in what felt like a long while, conversations were being had nationally about suicidality. Among the different points of conversation, some specific questions recurred:  

  • What actually happens when you call NSPL? 
  • Could someone in crisis recall this number?  
  • What should policymakers do about this? 

Enter 988. 

Five years after Logic released “1-800,” and about 17 years since the lifeline’s inception, 988 launched. This came after years of lobbying and passage of a bill officially establishing 988 in 2018. The core aims  of the original hotline and 988  the same – trained counselors providing crisis intervention and support to callers– but the means of getting connected now is a 3-digit number that people can quickly call or text.  In doing so, some of the specific questions were answered, bringing about both praise and additional concerns.  

The Praise 

NSPL, now also known as 988, is a service that provides lifesaving intervention. The line provides support to all callers, no matter if someone calls because they are concerned for someone else, or if they themselves are in crisis. Both the efficiency and the lift it provides to mental health structures have also been praised, as growing research on the impact of the line are published.  According to the National Alliance on Mental Illness (NAMI), more than 80% of crisis calls can be resolved on the phone. SAMHSA reports that fewer than 2% of calls require connection to emergency services or police.  

The Concerns 

Despite the successes of the NSPL, concerns have been mentioned on social media, including one particular post circulating on social media asking people not to promote 988. This stems from many factors, including individual experiences of callers. Underlying these individual experiences is the intricate interaction between 988 and police systems as well as fears around overuse of “involuntary holds,” in which people are placed (without their own permission) in a psychiatric facility to prevent harm to themselves or another person, versus having a choice about being placed in a 72-hour hold to prevent harming yourself or another person. Due to 988’s policies and practices, crisis counselors are required to contact emergency dispatch and/or 911 if someone expresses intent to harm themselves or others.  

This leads to another ongoing concern about the lack of training for police officers as it relates to mental health calls, particularly how these interactions have a higher chance of being fatal for disabled people, Black people, and People of Color. 

What Now? 

So…what are we to do with all this information?  

For starters, while 988 was established at the federal level, it is worth understanding how 988 varies from state to state. It is important to be up to date on your state’s 988 legislation which can provide you with the resources to accurately convey information, especially if you are a professional. Understanding who answers the phone is key as well. If a trusted agency in your city or municipality is the one addressing a crisis, that can make a huge difference in quality and outcomes for callers.  

Also, with any new program, needs and opportunities for improvements exist. It is important that stakeholders weigh in on any gaps they see, areas of additional need, and changes that could be made to avoid marginalizing or harming groups of people. Stakeholders and community members can also be helpful in identifying local resources for callers who are in crisis.  

Establishing the 988 number took advocacy. Now, making 988 a service that best supports all people is going to take some advocacy. If the journey to these three digits taught us anything, it’s that real change takes time but is possible. We hope you will go learn more about 988 in your state, talk to others about their experiences using 988, and get involved in the process of making this the best possible crisis hotline in your community.