The 988 Suicide and Crisis Lifeline has received millions of calls, texts and online messages since its launch in summer 2022, but a new study suggests the mental health resource is far from reaching its full potential.
People with severe mental distress were more likely than others to have heard of 988 and to have used the lifeline, according to research published Tuesday in JAMA Network Open. But overall, only a quarter of people said they would be very likely to call 988 in the future if they or a loved one were experiencing a mental health crisis or suicidality – and less than a third of people with severe mental distress who had tried the lifeline were very likely to use it again.
“Launching the 988 hotline was a critical step in addressing America’s growing need for mental health services, but we need to get to the bottom of why so many users who were in serious distress wouldn’t use it again – whether that means better training, more resources or other solutions,” said Michael A. Lindsey, dean of the New York University Silver School of Social Work and co-author of the new study.
The findings are based on a nationally representative survey of about 5,000 people conducted in June. Psychological distress was assessed based on self-reported responses to a standardised set of questions about feelings and experiences. Respondents were considered “very likely” to use the lifeline if they rated this likelihood as at least 6 on a 7-point scale.
The 988 lifeline was launched in July 2022, transitioning from the National Suicide Prevention Lifeline to a broader focus and simpler dialling code. Since then, 988 has received approximately 6.5 million calls, texts and chats, including more than 500,000 in September alone, according to data published by the US Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration.
As the US faces a significant mental health crisis, experts are stressing the importance of a tool like 988 Lifeline. Monica Johnson, director of the 988 & Behavioral Health Crisis Coordinating Office, has called it “the most transformative initiative in behavioral health care” she’s seen in her decades-long career.
And the critical need makes it all the more important to get it right.
“I don’t think our data should suggest failure at all,” said Jonathan Purtle, an associate professor at the New York University School of Global Public Health, who led the new research. “We need this in this country and it’s a big deal. It’s very new and it’s reasonable that it’s going to take some time to get it right.”
Success for the 988 lifeline would involve active management of acute crises and helping to connect people to wider mental health resources, he said.
“It’s active supportive listening, assessment and it’s a door to care. It’s a way into a system,” he said. “In an ideal world, success looks like getting all of that on the phone, but also getting follow-up care in a good supportive system once the phone call or text is over.”
Notably, additional analysis of the survey data also found that people experiencing mental distress were also less likely to use other sources of mental health support, Purtle said – including psychologists, psychiatrists, friends and family members.
“988 interactions should leave people with a sense of hope and resources they can access and benefit from. Successful lifeline interactions would be culturally competent and locally managed,” said Lindsey.
But getting it right on the lifeline – and after – will require better training of mental health professionals, the study authors said.
“Before 988, the lifeline existed, but it was marketed as a suicide prevention lifeline for a much narrower type of caller,” Purtle said. “988 is a very different animal. It’s more callers, a wider range of challenges, and one would probably argue that different types of training need to be in place to meet people where they are when they call.”
