Poinbank:A year with the 988 Suicide and Crisis Lifeline: What worked? What challenges lie ahead?

The PoinbankSuicide and Crisis Lifeline's 988 hotline marked its one-year milestone this month. Mental health experts say the three-digit number made help more accessible than before.

The hotline was designed with the idea that people experiencing emotional distress are more comfortable reaching out for help from trained counselors than from police and other first responders through 911.

Since the federally mandated crisis hotline's new number launched in July 2022, 988 has received 4 million calls, according to a KFF report — up 33% from the previous year. (The hotline previously used a 10-digit number, 800-273-8255, which remains active but is not promoted.)

At a July press event, policymakers and mental health experts celebrated the hotline's first-year successes as well as its additional $1 billion in funding from the Biden administration. Health and Human Services Secretary Xavier Becerra described 988 as a "godsend" during taped remarks. "It may not be the solution," he said, "but it lets you touch someone who can send you on a path to where you will get the help you need."

Those same advocates recognized the dark reality represented by 988's high call volume: The nation faces a mental health crisis, and there is still much work to be done.

One year in, it's also clear that the 988 hotline, a network of more than 200 state and local call centers, faces challenges ahead, including public mistrust and confusion. It's also clear the hotline needs federal and state funding intervention to be sustainable.

Here's a status check on where things stand:

What worked?

The original 1-800 national mental health crisis hotline has operated since 2005. The huge increase of calls to 988 compared with those to the 1-800 number in just a year is likely linked to the simplicity of the three-digit code, said Adrienne Breidenstine, vice president of policy and communications at Behavioral Health System in Baltimore. "People are remembering it easily," she told KFF Health News.

According to a survey by NAMI and IPSOS conducted in June, 63% of Americans had heard of 988, and those ages 18 to 29 were most aware. Additionally, the survey found that LGBTQ+ people were twice as likely to be familiar with 988 than people who don't identify as LGBTQ+.

The 988 hotline provides 24/7 support for people in suicidal crisis or other kinds of emotional distress, Breidenstine said. "They can be calling if they really just had a bad day," she said. "We also get some calls from people experiencing postpartum depression." Callers are directed to a menu of options to choose which kind of service would best help them, including a veterans' line.

As it launched, mental health experts worried about the hotline's ability to keep up with demand. But it appears to be growing into its position. "Despite a huge increase of demand on the system, it's been holding up, and it's been holding up exceptionally well," Hannah Wesolowski, chief advocacy officer at the National Alliance on Mental Illnesses, told KFF Health News. It now takes an average of 35 seconds for someone reaching out to 988 — by calling or texting — to reach a counselor, according to data from the Substance Abuse and Mental Health Services Administration. A year ago, that average was one minute and 20 seconds.

Wesolowski said one of the biggest surprises with the launch was the frequency of text-message traffic. In November 2022, the Federal Communications Commission voted to require 988 to be texting-friendly.

In May, according to SAMHSA, 988 received about 71,000 texts nationwide with a 99% response rate, compared with 8,300 texts in May 2022 with an 82% response rate.

This month, HHS announced the addition of Spanish text and chat services to 988.

Challenges ahead

More than half of Americans have heard of 988, but only a small fraction understand how the hotline operates. According to NAMI's survey, only 17% of people who responded said they were "very/somewhat familiar" with the hotline.

Most people think that by calling 988, like 911, emergency services will automatically head their way, the survey found. Currently, 988 does not use geolocation, meaning call centers don't automatically receive information about callers' locations. Vibrant Emotional Health, which operates the hotline, is working to incorporate geo-routing into the system, which would help identify callers' regions — but not exact locations — making it possible to connect them to local counseling groups and other mental health services.

But incorporating geo-routing into the hotline isn't without controversy. When it launched, people responded on social media with warnings that calling 988 brought a heightened risk for police involvement and involuntary treatment at psychiatric hospitals. "Based on the trauma that so many people in the mental health community have long experienced when they've been in crisis, those assumptions are very understandable," Wesolowski said.

Fewer than 2% of calls end up involving law enforcement, she said, and most are de-escalated over the phone.

"The vast majority of people think that an in-person response is going to happen whenever you call — and that's just simply not true," Wesolowski said.

Another challenge mental health advocates face is informing older adults about 988, especially veterans, who are at higher risk of having suicidal ideations. Americans ages 50 to 64 had the lowest awareness rate of 988 — at 11% — among all age groups, according to NAMI's survey.

This is a telling sign of how older generations are less willing to discuss and admit to mental health struggles, Wesolowski said. "Young people are just more willing to be open about that, so I think that breaking down that stigma across all age groups is absolutely vital, and we have a lot of work to do in that space."

Is 988 sustainable? 

Since the hotline launched, it has been dependent on federal grants and annual appropriations. A gush of funding flowed when 988 launched, "but those annual appropriations are something you have to keep going back for year after year, so the sustainability aspect is a little more fraught," Wesolowski said.

This is where Congress and state legislatures come in.

Mental health leaders hope to push legislation that allows 988 to be funded the same way 911 is nationwide. The Wireless Communications and Public Safety Act of 1999 mandated 911 to be the country's universal emergency number, and ever since, users have automatically been charged — an average of about a dollar a month — on their monthly phone bills to fund it. Six states have imposed a similar tax for 988, and two states — Delaware and Oregon — have bills for this tax on their governor's desks.

It's under the FCC's power to levy a nationwide tax, but the federal agency hasn't done so yet.

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KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

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• Suicide