In July 2022, the 988 Suicide and Crisis Lifeline became active across the United States. For suicide prevention advocates, the new three-digit dialing code is a welcome upgrade to the 10-digit National Suicide Prevention Lifeline. (The previous Lifeline number, 1-800-273-TALK, continues to function indefinitely.)

“Having a three-digit number for crisis counseling is equivalent to being able to call 911 instead of trying to remember the 10-digit number for the fire department when your house is on fire,” said Matthew Wintersteen, PhD, a suicide prevention expert and Director of the David Farber ASPIRE Center at Thomas Jefferson University. “The launch of 988 also advances the important conversation around mental health in this country.”

The 988 Lifeline is an important resource that psychologists can and should share with patients, advocates say. Instead of telling patients who are suicidal to call 911 or go to the nearest emergency room, psychologists can encourage their patients to call 988 if they are unable to reach their provider, Wintersteen said.

Here’s what psychologists and other mental health practitioners should know about this new resource.

A lifeline for people in crisis

Originally launched in 2005, the Lifeline is a national network of more than 200 local crisis centers that provide free, confidential, 24/7 support to people in suicidal crisis, substance use crisis, or emotional distress. The service is available through voice calls, text messages, and online chats at 988lifeline.org.

The 988 number for the Lifeline was established through the bipartisan National Suicide Hotline Designation Act, which was passed in 2020. The goal was to make it easier for people to access help in a crisis. The legislation also increased federal investments to improve response rates, increase capacity, and ensure calls are routed appropriately to local, regional, and state crisis call centers. “Along with the number comes an increase in crisis services,” said Jill Harkavy-Friedman, PhD, a psychologist and senior vice president of research at the American Foundation for Suicide Prevention (AFSP). (APA CEO Arthur C. Evans, Jr., PhD, is on the board of the AFSP.)

In 2020, 1.2 million people attempted suicide, and 45,979 died by suicide, according to the AFSP. Research shows that many suicides are impulsive acts, and having access to 24/7 support has can save lives. “In a crisis people don’t have access to their usual coping mechanisms. But we have techniques to help,” Harkavy-Friedman said. “People in crisis need someone who can de-escalate the situation.”

Calling 988: What to expect

The Lifeline is designed to address all types of mental health crises, and it’s a resource that should be shared with patients whether or not they are at increased risk of suicide, Wintersteen said. But it can be helpful to talk with patients ahead of time about what they might experience if they need to call or text. “It’s important to inform people about what will happen so they have realistic expectations,” Harkavy-Friedman said.

She suggests some pointers to share with patients when discussing 988:

• It’s important to discuss with patients what to do in a crisis, including how to reach you and what to do if you are not available. Crisis center counselors might ask if a patient is receiving mental health care, and if so, whether they have tried to reach out to their provider.
• If patients can’t reach you, 988 is a resource for anyone experiencing thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress.
• The 988 Lifeline is free and confidential.
• Callers might have to wait a few minutes to be connected to a crisis center in their area.
• Military veterans who call 988 can dial “1” to be connected to a dedicated veteran call center.
• Trained crisis counselors only call the police as a last resort, when it’s essential to saving the caller’s life.

Patient fears about 988

After 988 was unveiled, some individuals used social media to warn against the service, arguing that it could lead to involuntary hospitalizations or unwanted law enforcement visits. Although those are possible outcomes, experts say they are rare.

In fact, compared with calling 911, dialing 988 may be less likely to lead to a law enforcement dispatch. Data show that roughly eight in 10 Lifeline calls are resolved over the phone. Counselors can often diffuse the immediate crisis while providing resources and referrals for additional treatment and support.

A small minority of calls result in law enforcement response, but only when it’s deemed necessary, Harkavy-Friedman added: “The goal is to help save their life.”

Advancing suicide prevention: How psychologists can help

Organizations including APA and AFSP advocated for the creation of 988, and its launch is a success story for mental health advocacy. “So many members of the behavioral health community worked together to make this happen,” said Julio Abreu, senior director of congressional and federal affairs at APA. “It shows what we can accomplish when we work together to improve policies related to mental health.”

Yet there is more work to be done. Before the switch to a three-digit number, the Lifeline’s network of call centers answered more than 2 million crisis calls per year. The call volume has already increased following the implementation of 988, and it’s expected that calls to the Lifeline will continue to grow. “We need to continue to build our network of crisis centers,” Harkavy-Friedman said.

The federal legislation authorizing 988 requires funding from states, but not all states have a sustainable plan yet for how to fund these services. “Psychologists can help advocate for funding at the state level. Your voice matters,” Harkavy-Friedman said.  APA, and our sister behavioral health groups, will need to remind lawmakers every year of the profound need for state and federal investments to ensure the sustainability of the 988 Lifeline.

Meanwhile, psychologists in clinical practice should make sure they are up to date on the evidence-based modalities for suicide risk assessment and intervention. “Encounters with patients who are suicidal is inherent in our field, and we have to be confident in doing this work,” Wintersteen said. “988 is a fantastic resource, but we can’t rely on it to be the be-all and end-all of suicide risk assessment. As clinicians, we need to make sure we're doing our part.”

By Kirsten Weir
Date created: October 7, 2022