Facilitated by a federal investment of around $1 billion, the Lifeline has fortified its response capacity, leading to a surge in engagement via calls, texts, and chats

The US suicide prevention hotline, 988, is helping a greater number of individuals in distress since 2005. In its inaugural year, the Lifeline responded to almost 5 million calls, texts, or online chats, marking a notable increase of 2 million compared to the previous year, the Journal of the American Medical Association (JAMA) reported.

Facilitated by a federal investment of around $1 billion, the Lifeline has fortified its response capacity, leading to a surge in engagement via calls, texts, and chats.

Every 11 minutes, someone in the US dies by suicide. That grim statistic, from 2021, reflects a 36% increase in suicide rates over the previous two decades, according to the Centers for Disease Control and Prevention (CDC).

In 2001, Congress funded a suicide prevention hotline due to increasing suicide rates, particularly among young people. The National Suicide Prevention Lifeline was launched in 2005, managed by Vibrant Emotional Health. Starting as 1-800-273-TALK (8255), it received around 46,000 calls in 2005. Over a decade, it responded to over 2 million calls in 2017. Rising suicide rates make it hard to measure success, but a song by Logic, “1-800-273-8255,” brought the Lifeline attention and potentially saved lives.

In 2021, suicide was one of the nine leading causes of mortality in the US among people aged 10 to 64 years, CDC data shows. Provisional 2022 data indicates that there were nearly 50 000 deaths by suicide last year, approximately 2.6% more than in 2021. One bright spot: the suicide rate for 10- to 24-year-olds appeared to decrease in 2022. But it increased for people older than 24 years, the JAMA reported.

In July 2022, the National Suicide Prevention Lifeline made it easier to get help during crises by changing its number to a simple 3-digit code: 988. This change has led to more people reaching out for assistance through calls, texts, and online chats, and they’re getting quicker responses. However, even though things have gotten better, there are still some states finding it hard to answer all the calls, and lots of people don’t know about this service or that 988 is the number to use.

“Still, politicians argued that the 1-800 number was too cumbersome. In an effort to make the dialing code easier to remember, the bipartisan National Suicide Hotline Improvement Act of 2018 required SAMHSA and the Federal Communications Commission (FCC) to evaluate the practicality of paring it down to 3 digits. The FCC agreed that the benefits of a shorter number would likely outweigh the financial costs of changing the dialing code, and the digits 988 were chosen. Congress approved, and the National Suicide Hotline Designation Act of 2020 was signed into law, confirming 988 as the new number. The act also mandated a strategy to provide crisis services tailored to populations at higher risk of suicide,” the JAMA reported in its latest article published on August 30.

Titled as “How the New 988 Lifeline Is Helping Millions in Mental Health Crisis” the article says the the Lifeline comprises a network of more than 200 state and local crisis centers.

“Part of a roughly $1 billion federal investment allowed the Lifeline to add 10 centers, bringing the current total up to 215, Vibrant Emotional Health noted in an email. As before, counselors are available around the clock, 7 days a week for anyone who needs to talk, even if they aren’t contemplating suicide.”

“It’s for any kind of crisis—emotional distress, substance abuse, a mental health crisis, or people who just aren’t sure where to turn next,” Emmy Betz, a professor of emergency medicine at the University of Colorado who studies suicide prevention, said in an interview with JAMA.

The Lifeline’s ultimate goal is to provide emotional support while reducing stress and guiding healthy decisions, often without the need for emergency services such as 911.

“It is an intuitive mental-health equivalent of 911, and this helps divert calls that would otherwise be made to 911 for mental health crises,” Richard Liu, PhD, an associate professor of psychology at Harvard Medical School, wrote in an email.

“988 is one stop on the crisis continuum,” Tia Dole, the chief 988 Suicide and Crisis Lifeline officer at Vibrant Emotional Health, said in an interview. “The key is to reach people before they are standing on a bridge, literally and figuratively.”

Since the switch to 988, more people in crisis have been reached. In its first year, the Lifeline answered nearly five million calls, texts, or online chats, two million more than were answered in the prior year. The number of answered calls and chats increased by 46% and 141%, respectively, and answered texts rose by more than 1000%. The federal government’s approximate $1 billion investment allowed the Lifeline to bolster its capacity to respond and “is driving an increase in calls, texts, and chats,” SAMHSA’s email mentioned.

The average answering speed also dropped, from longer than 2 minutes down to 41 seconds.

“The reduced wait times and increased answered contacts are a success for the 988 Lifeline,” Ajilore remarked, adding that it “appears to be driven by an increased capacity and infrastructure for local call centers to answer texts/chats.”

Liu agrees that more responses reflect the 988 Lifeline’s successful launch. “It means a high number of individuals with otherwise unmet needs are now reaching someone who can provide initial support and resources,” Liu wrote. However, he cautioned that “sustaining capacity will be important and dependent on continued support at the federal and state level.”

“Our goal for fiscal year 2024 is to get under 30 seconds, because each second counts,” said Dole, who is also a clinical psychologist. “The longer people wait, the less likely they are to stay on the line.”

“Individuals from various demographic groups may do better talking with someone who really understands their perspectives, backgrounds, or specific concerns,” Betz said.

The Lifeline is also increasing access for people who are deaf or have hearing impairments. Although relay services exist, 988 plans to implement a video phone service.

“This is something that our partners have been speaking about as a barrier and as an inequity in terms of access,” said John Palmieri, who oversaw the 988 rollout as a senior medical advisor at SAMHSA as well as the acting and deputy director of its 988 & Behavioral Health Crisis Coordinating Office. “By the end of this fiscal year, we will be able to launch services through American Sign Language.”

Despite its streamlined dialing code and accessible services, the Lifeline still needs a push to get the word out.

“As a health care community, we need to continue advocating for funding—for both research and provision of mental health services,” Betz said. “Hotlines like 988 really depend on having places to refer people to, so if we don’t have adequate and accessible mental health treatment, we’re going to run into problems.”

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