The United States’ first nationwide three-digit mental health crisis hotline went live on Saturday, July 16. It is designed to be as easy to remember and use as 911, but instead of a dispatcher sending police, firefighters or paramedics, 988 will connect callers with trained mental health counselors.

The federal government has provided over $280 million to help states create systems that will do much more, including mobile mental health crisis teams that can be sent to people’s homes and emergency mental health centers, similar to urgent care clinics that treat physical aches and pains.

“This is one of the most exciting things that has happened” in mental health care, said Dr Brian Hepburn, a psychiatrist who heads the National Association of State Mental Health Program Directors.

Hepburn cautions that when 988 kicks off, it will not be like “the flick of a switch. It’s going to take a number of years in order for us to be able to reach everybody across the country.”

Some states already have comprehensive mental health crisis systems, but others have a long way to go. And widespread shortages of mental health specialists are expected to slow their ability to expand services.

A RAND Corp survey published last month found that fewer than half of state or regional public health officials were confident about being ready for 988, which is expected to generate an influx of calls.

Nearly 60% said call-center staffers had specialized suicide prevention training; half said they had mobile crisis response teams available 24/7 with licensed counselors; and fewer than one-third had urgent mental-health care units.

The 988 system will build on the National Suicide Prevention Lifeline, an existing network of over 200 crisis centers nationwide staffed by counselors who answer millions of calls each year — about 2.4 million in 2020. Calls to the old lifeline, 1-800-273-8255, will still go through even with 988 in place.

“If we can get 988 to work like 911 … lives will be saved,” said Health and Human Services Secretary Xavier Becerra.

Dispatching paramedics for heart attacks and police for crimes makes sense — but not for psychiatric emergencies, mental health advocates say. Calls to 911 for those crises often lead to violent law enforcement encounters and trips to jail or crowded emergency rooms where suicidal people can wait days for treatment.

The 988 system “is a real opportunity to do things right,” said Hannah Wesolowski of the National Alliance on Mental Illness.

Sustained funding will be needed. According to the National Academy of State Health Policy, four states have enacted laws to impose telecommunications fees to support 988 and many others are working on the issue.

A desperate call to a Utah state senator in 2013 helped spark the idea of a three-digit mental health crisis line.

Senator Daniel Thatcher says a good friend sought his help after taking his suicidal son to an emergency room, only to be told by a doctor to come back if the boy hurt himself.

Thatcher has battled depression, and at 17 he also considered suicide. He knew that despondent people in crisis may lack the wherewithal to seek out help or to remember the 10-digit national suicide lifeline number.

Thatcher found that many of Utah’s in-state crisis lines went straight to police dispatchers or voicemail. He wondered why there was no 911 service for mental health, and the idea got national attention after he mentioned it to longtime Sen Orrin Hatch.

In 2020, Congress passed the bill designating the 3-digit crisis number and then-President Donald Trump signed it into law.

Thatcher’s mother was a nurse and knew where to get him help. He says 988 has the potential to make it that easy for others.

“If you get help, you live. It really is that simple,” Thatcher said.

NAMI FAQ Site

NAMI, the National Alliance on Mental Illness has published a comprehensive FAQ site — review it by visiting nami.org/NAMI/media/NAMI-Media/PDFs/NAMI-FAQs-for-Nationwide-Availability-of-988.pdf.

The Q&A content of the site highlights the following:

Can I only call or text 988 if I am experiencing a life-threatening crisis?

No, you can call or text 988 for yourself or a loved one if you are in any type of emotional distress. However, if you are not in a crisis, there are other services that may meet your current needs better, including a peer-support Warmline for emotional support or the NAMI HelpLine (1-800-950-NAMI or helpline@nami.org) for information, resources and support.

How can I reach 988? Only by phone?

You can call 988, text 988 or chat via the Lifeline’s website (988lifeline.org).

What happens when I call 988? What information will I receive, or does the Lifeline only offer immediate crisis support?

The goal of the 988 Lifeline is to provide free, confidential, immediate crisis intervention and support. When you call or text or chat 988:

You’ll hear a message that you’ve reached the National Suicide Prevention Lifeline — you are in the right place! If you are a veteran, you can press “1” to reach the Veterans’ Crisis Line or “2” to reach the Spanish subnetwork for the Lifeline.
If you don’t select either option, a trained crisis counselor will answer.
The counselor will listen to you to understand how your problem is affecting you or your loved one.
The counselor will provide support and share resources and referrals.

In some communities, the crisis line may be able to connect you to additional services or follow up with you to ensure you’ve connected with care (note: not all communities have this capacity).

Can I only call 988 for myself, or can I call for someone else I know or see in crisis?

You can call or text 988 if you are concerned about someone else in distress who may need crisis support.

Does 988 collect my information/data? What do they do with that information?

All contacts with the 988 Lifeline from people seeking help are confidential. According to the Lifeline FAQs, information about callers/chatters/texters will not be shared outside the Lifeline without documented verbal or written consent from the person seeking help, except in cases where there is imminent risk of harm to self or someone else, or where otherwise required by law.

The Lifeline protects all the confidential and identifying information shared. During your contact with the 988 Lifeline, you may voluntarily share certain information about yourself that could be identified, and that information may be documented in notes about your conversation. The center may also have access to the phone number or IP address you used to contact the Lifeline.

You will never be required to provide other identifying information to receive help from the Lifeline. The Lifeline may use de-identified and aggregated data for reports to stakeholders, funders and policymakers about the numbers and types of conversations they have with people in crisis. They might also reference the general aggregate demographics of people seeking help from the Lifeline.

CTMirror and Associated Press content from Lindsay Tanner is used in this report.

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