The new 988 crisis line: What clinicians should know

There’s a new must-know number for healthcare professionals (HCPs). As of July 16, 2022, 988 are the go-to digits for people in the midst of mental health crisis or who are grappling with substance abuse.

The 988 Suicide & Crisis Lifeline replaces the National Suicide Prevention Lifeline, offering around-the-clock call, text, and chat support with mental health professionals.^[]

The old number (1-800-273-8255) will route callers to the new 988 system. While the new number represents a step forward in easing access to mental healthcare, some say that there is room for further improvement.

Inside the new number

Local responses

Unlike its predecessor, the 988 system is decentralized, offering localized responses to those in crisis. When someone calls, they’re connected to a local crisis center corresponding to the caller’s area code. Counselors field the calls, assess problems, and provide callers with appropriate resources. If a local center’s lines are full, calls are routed to national crisis centers.

Call centers can currently field calls in Spanish or English. The lifeline has also incorporated a translation service that can handle more than 250 languages.

Communication options

Unlike the previous hotline, 988 offers multiple communication options. People in distress can call, text, or chat. When a person texts, a group of crisis centers respond, connecting people with counselors who provide support and resources. Currently, 988 texting is only supported in English. The service remains in its infancy, slated to “expand over the next few years to increase local and state level response.”

People also have the option of using a web-based chat at 988lifeline.org/chat. Like the text-based support, chat support is currently only offered in English. Those needing help complete a survey and are connected with a counselor. When demand is high, users may see wait-time messages and can view a resources page. Once connected with a counselor, support is similar to the other platforms.

More than suicide prevention

People in crisis (or their loved ones) can reach out for help with thoughts of suicide, other mental health concerns, and/or problems with substance use.

Separate from 911

While police and firefighters are well-trained to respond to crimes and fires, they may lack robust training to assist those contending with a mental health crisis. A 2020 Washington Post investigation highlighted these limitations.^[]

Investigators determined that in 2019, one in five victims of fatal police shootings was mentally ill. They noted that larger, better-funded police departments in metropolitan areas have made progress by rolling out de-escalation training. But the number of fatal shootings in medium or small metropolitan areas, as well as rural areas, remained flat between 2015 and 2019.

The 988 Lifeline presents an alternate solution that's “distinct from the public safety purposes of 911,” according to the Substance Abuse and Mental Health Services Administration (SAMHSA), which noted the systems will be “closely coordinated.” SAMHSA said crisis counselors will coordinate with 911 if someone's life appears to be at risk.

Room for improvement

In an MDLinx interview, Apran Waghray, MD, CEO of Well Being Trust, a philanthropic organization working in the mental health space, welcomed the new 988 system, which he said is poised to stem the loss of lives to suicide, drugs, and alcohol.

However, he felt the new system is far from a finished product, saying much of the work ahead will involve coordinating and strengthening a patchwork of state mental healthcare programs.

“The launch of 988 serves as an opportunity to shift the tide if federal and state leaders are willing to make meaningful investments in the hotline's long-term success,” Dr. Waghray said.

According to Dr. Waghray, that means staffing call centers, training call-center employees, and boosting the number of beds at in-patient facilities. Even raising public awareness about the new number is a work in progress. The plight of police-involved shootings, he said, highlights this.

“A month into 988’s launch, we’re still far from that reality," Dr. Waghray continued. "Officials must set realistic expectations when raising public awareness of this hotline to ensure those in crisis are aware that a police response is possible—or even expected, in some instances. Without communicating these expectations, we risk harming public trust in the already struggling mental health system.”

Eliminating barriers

Much like how 911 eased access to emergency services, 988 is poised to eliminate many of the traditional barriers for access to mental healthcare. However, there are a few areas for logistical improvement here as well.

Since it’s a localized system, people in certain locations may face longer wait times than others. Further complicating the issue, only 21 states have enacted legislation to fund the 988 system.^[]

Also, it may be a while before call centers are fully staffed and trained, including support for the LGBTQ+ community, youth, communities of color, new mothers, and others. Cultural competency, Dr. Waghray said, is essential for this new system.

Finally, although people will receive the support they need while in crisis, healthcare as a whole is expensive. People may not be able to afford in-patient care or medications that may follow a call to 988.

Regardless, Dr. Waghray called the rollout a step in the right direction.