- Since July 2022, the National 988 Suicide and Crisis Lifeline has answered over 2 million calls.
- The new, shorter number makes it easier for people in crisis to reach out for help.
- Individuals in crisis can now call, text, or chat with trained mental health workers around the clock.
- Community prevention and crisis intervention agencies are collaborating to define an ideal system of response.
On a cold January day in 1988, my younger brother made a desperate call to a crisis hotline. His favorite operator was not working, so he hung up. Matthew was 18, a freshman at the University of Alaska, far from home while pursuing his passion, wildlife conservation. In a perfect storm of despair and long-term depression, my brother ended his life.
In the sorrowful aftermath of investigations, we learned that Matthew made many calls to the hotline since starting school in September. His requested crisis operator believed that Matthew had a “crush” on her. As I contemplate my crushed and lonely brother "crushing" on the compassionate listener on the other end of his perceived lifeline, it makes perfect sense. Aren’t we all attracted to others who “see” us without judgment? Aren’t we all craving authentic human connection and a space to share our deepest pain, fears, and vulnerabilities?
For the past 35 years, I’ve wanted to thank the young, anonymous operator. I am grateful for the care she provided, helping Matthew feel emotionally embraced enough to survive another day…until his last call.
Today, with the universal 988 Suicide and Crisis Lifeline number, we have more consciously collaborated community support to reduce the alarming numbers of deaths by suicide. For the first time, networks of mental health providers and prevention agencies are uniting to help 988 become a successful entry point for mental health needs. The goal of dedicated 988 rollout boards is to define and standardize an ideal system of response to callers in crisis.
The Emotional State of Our Union
In the last 20 years, suicide rates have increased 36 percent and over 12 million American adults reported having serious thoughts of suicide (CDC, 2023). These deaths of despair occur every 11 minutes in our country (CDC, 2023). For U.S. high school students, 44 percent (more than one in three) report feeling “sad or hopeless almost every day for two weeks in a row” (CDC, 2022). Adolescent suicides (ages 15-19) have increased 29 percent in the last decade (CDC, 2022).
In May 2023, the US Surgeon General declared loneliness to be at epidemic proportions. Loneliness and isolation are key risk factors contributing to mental health struggles. According the Interpersonal Theory of Suicide (Joiner, 2005), there are three essential components:
- Perceived burdensomeness
- Thwarted belongingness
- Capability to follow though
Unfortunately, my brother had all three boxes checked on the day he died.
How 988 Answers the Need
The 988 Suicide and Crisis Lifeline number was launched July 16, 2022 to replace 1-800-273-TALK. As a licensed psychotherapist who has written down the old, eleven-digit number on sticky notes for hundreds of clients over the years, my initial response was, “It’s about time.” I used to wonder, “How is someone with depression and suicidal ideation supposed to remember or find this number when the need arises?”
The new, three-digit number connects callers within seconds to trained counselors, usually within their community (based on area codes). The 988 platform serves all individuals in crisis needing confidential, free, mental health support, 24 hours a day, 365 days a year. It also allows individuals to text or chat. There are specific connections for at-risk groups, including veterans, Spanish-speaking, and LGBTQI+ callers.
Suicide hotlines work by providing individuals a place to be heard, supported, and ultimately, connected to community resources. Today, 988 calls are answered by mental health workers (paid or volunteer) in over 200 crisis centers across the country, funded by federal, state and local agencies. The FY2024 budget proposal under the Biden administration requests $830 million in federal funding for 988.
The goal for each call is to de-escalate the crisis situation, assess the severity and intent for harm to self or others, and offer empathic support services. Since the rollout, qualified counselors have answered over 2 million calls, and another 1 million chats and texts (Vibrant, 2023). According to performance metrics for May 2023, there were 402,294 requests to the 988 line (93 percent were answered and 7 percent abandoned or hung up) with an average response time of 35 seconds (Vibrant, 2023). Calls average 20 to 40 minutes, with callers ranging from eight years old to senior citizens.
A progressive plan for therapeutic services during and following each call is ideal. While not every state is staffed similarly, Northeast Florida employs a dedicated team of paid crisis call workers directed and coordinated by a collaborative board of agency leaders.
“It is imperative that we identify solutions together and have clear, established pathways for our callers to connect to our community’s critical mental health services,” says Jeff Winkler of the United Way of Northeast Florida.
Oftentimes, callers in Northeast Florida are connected with intermediary agencies to continue the healing dialogues. One agency, Here Tomorrow, in Jacksonville, offers free sessions with peer counselors before longer-term mental health resources are established.
When I shared my brother’s story, Elizabeth Findley, the 988 director of Northeast Florida United Way replied, “Our training modules teach crisis care workers how to maintain trust while establishing clear and firm boundaries so that callers are not dependent on any one operator.” Through motivational interviewing, operators help suicidal callers feel connected enough to share their pain while co-creating safety plans. Findley would encourage a caller like my brother to stay on the line by saying, “I think it’s cool that you established a relationship with ‘X.’ Would you be interested in talking with me? I’m here to help you with whatever is going on.”
Just like a personal assistant might be the first line of introduction to a business, hotline operators are often the first line of introduction to crisis management, counseling, and healing. To all who are answering these life or death calls, I say, “Thank you.” As a sister of suicide, I appreciate the vital role you play as paramedics of heartache and humanitarians of hope.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 contact the 988 Suicide & Crisis Lifeline by calling or texting 988, or the Crisis Text Line by texting HOME to 741741. To find a therapist near you, see the Psychology Today Therapy Directory.
Centers for Disease Control and Prevention (2023), Facts about suicide.
Centers for Disease Control and Prevention (2021). Youth risk behavior survey data summary and trends report: 2011-2021.
Centers for Disease Control and Prevention (April 2022). Adolescent behaviors and experiences survey--January-June 2021. Morbidity and Mortality Weekly Report, vol 7 (3).
Joiner, T. (2005). Why people die by suicide. Harvard University Press.