A checkup for the 988 Suicide and Crisis Lifeline at 2: Still lots to do

Liz Orviz first reached out to the 988 Suicide and Crisis Lifeline shortly after the number launched in July 2022.

“It was a very frustrating and just a really negative experience,” recalls the 40 year-old, who lives near Detroit, Michigan.

She was struggling with depression and thoughts of suicide when she tried texting 988 for help. But in order to connect with a counselor, she had to first read through a set of terms and conditions, and privacy and security statements. “When I am in a depressive crisis, I'm not able to read,” she says. “I couldn't do it. So then I called and they put me on hold.”

After holding for several minutes, Orviz hung up. But a few months later, when her suicidal thoughts returned, she tried calling 988 again. This time, she had a completely different experience.

“They picked up right away,” says Orviz. “They were very compassionate. They said, ‘What coping skills have worked for you in the past? Have you tried any of them? What else could we try?’”

It’s just the kind of help she needed at that moment.

Orviz is among the millions of people who have contacted the 988 Suicide and Crisis Lifeline in the past two years. And her experience with those calls over time also reflects how the Lifeline has evolved in its ability to help people in need.

Speaking at a press conference on Tuesday, the second anniversary of 988, White House Domestic Policy Adviser Neera Tanden said the Biden-Harris administration has invested $1.5 billion towards beefing up and supporting 988 and its more than 200 call centers across the country.

“I’m proud to announce that 988 has answered more than 10 million contacts – that is 10 million times a person received confidential crisis care through phone, text or chat,” said Tanden.

Additional data released by U.S. Health and Human Services also shows that the Lifeline’s efforts to add and expand services to diverse and vulnerable populations has started to pay off.

There were 20,000 chats and texts in Spanish, a service added about a year ago. And there were 90,000 calls in Spanish. Nearly 500,000 LGBTQIA+ youth have contacted 988 since last year. And 20,000 American Sign Language users have used the ASL videophone option now offered by 988.

The Veterans Crisis Line, available through a ‘Press 1’ option, has answered more than 1.6 million calls in the past two years, according to a press release by the U.S. Department of Veterans Affairs.

“Overall, I think it's doing great and it's saving lives,” says Hannah Wesolowski, chief advocacy officer at the National Alliance for Mental Illness (NAMI). “Answer Rates are high. People's wait times to talk to somebody on the phone are down.”

But Wesolowski and other mental advocates also say that the Lifeline still has a long way to go. “There's still a fair amount of work to do to make sure everyone's needs are getting met,” says Wesolowski.

A mixed bag

The Lifeline's accomplishments and shortcomings are both reflected in a new poll by NAMI, released earlier this week.

The number of people contacting 988 is still a fraction of the population. Only 3% of respondents said they or a loved one reached out to 988 during a mental health, substance abuse or suicide crisis.

However, a large majority of individuals reaching out found help, the poll found.

“Of the people who report contacting 988, about 7 in 10 say they got the help that they needed,” says Wesolowski.

Jen Basinger, in Cincinnati, Ohio, is in that group. Basinger says she has called and texted 988 “approximately 50 times.” “I live with mental illness [and] 988 has kept me alive,” Basinger wrote in an email. “They are kind and helpful.”

But as Orviz and another user told NPR, the help they receive from the Lifeline can be unpredictable.

Diona Peddie, 36, in New York City, has called the number anywhere between 10 to 15 times since it started.

“It's gotten better, but it's sometimes positive and sometimes not so positive,” says Peddie. “There are times where I'll get somebody who's extremely helpful and I feel much better.”

But sometimes, she’s been on hold for as long as 15 minutes and hung up without talking to anyone. At other times, she says, she’s spoken to counselors who haven’t been very helpful.

“Sometimes, I'll get somebody who maybe isn't really experienced,” says Peddie. “So, it seems like they don't really know what to say.”

Orviz has had similar experiences during some calls, too, where some counselors wanted Orviz to lead the conversation. “For me, it's much better if they lead it,” she says. “I'm at a point where I'm in crisis. I can't think straight.”

Problems like “long wait times, individual crisis counselor inconsistencies” are “outlier experiences,” according to Tia Dole, Chief 988 Lifeline Officer at Vibrant Emotional Health, the nonprofit that oversees the entire 988 network of over 200 call centers.

"The overwhelming majority of contacts are answered and have Quality Improvement (QI) requirements for our centers," Dole wrote in an email. "We encourage anyone with poor experiences to let us know through our Contact Us page, so that we can investigate and problem-solve in order for those experiences to not happen again."

Variations across the country

One problem is that the 988 Lifeline doesn’t rely solely on federal funding. Individual crisis centers still depend greatly on state and local funding.

"We live in a country where every state is making up its own rules, passing its own laws, and providing its own funding for these services," says Angela Kimball, chief advocacy officer at Inseparable, a mental health nonprofit.

”And that means there are very disparate systems from state to state and even between counties in a state. So there is an unevenness, and I think that's a real challenge.”

For example, only 10 states have passed legislation that allow cell phone carriers to add a monthly fee for consumers – much like the fee people pay for 911 services – to help fund 988 and its services.

Those states are California, Colorado, Delaware, Maryland, Minnesota, Nevada, Oregon, Vermont, Virginia and Washington.

That’s an important step toward creating sustainable funds for 988 services, says Bob Gebbia, CEO of the American Foundation for Suicide Prevention.

“It's sustainable,” says Gebbia. “It's a few pennies per bill, but when you multiply that by all the people in our country who are paying phone bills, it starts to really create a viable, sustainable source at the state level.”

“But it isn't enough,” cautions Kimball. “States like Virginia have required that commercial insurance plans cover mobile crisis teams and crisis stabilization facilities. I think that's also key.”

But most states don't have sustainable sources of funds for 988 and all the services it provides, according to an analysis by Kimball and her colleagues published in a recent report.

“People need and deserve a better response, and often they're not getting it,” says Kimball. “And that's going to take real investment and real dedication to build the kind of system that people deserve.”

Lack of awareness

Another challenge facing the 988 Suicide and Crisis Lifeline is that only a minority of Americans are familiar with it.

As the new NAMI poll shows only 23% of respondents said they are very or somewhat familiar with 988.

“So awareness has not grown that much,” says Gebbia. “I am starting to see posters, things on train stations. We're starting to see more of that, which is great, but we know we have to do a lot more to make the public aware of it because we know there are people who are struggling and are not calling.”

The Substance Abuse and Mental Health Administration is launching a five-month national ad campaign this year to raise awareness about 988.

This has to be a priority, says Gebbia, because suicide remains a leading cause of death in this country.

“Over 49,000 people in our country are taking their lives,” he says. “That number has to start to come down.”

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