What mental health activists are saying about the 988 suicide hotline

WOODLAND PARK, N.J. – The National Suicide Prevention Lifeline's shortened number, 988, rolled out on July 16. Hours after launching, mental health activists and providers praised the government's attention to improving support systems — and pointed out potential pitfalls.

Shrinking the 988 Suicide and Crisis Lifeline hotline made it a simpler number like the universally memorized 911, though people can still dial the national lifeline's original 10-digits.

But "there is still a lot of work to be done,” explains 988's webpage. Activists and providers have ideas for what comes next. That largely entails further separating mental health crisis responses from law enforcement and investing in community-based organizations that cater to specific identities.

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The new 988 lifeline number aims to divert mental health, suicide or substance abuse crisis calls from 911. However, if a 988 operator determines that a caller presents an imminent risk to themselves or others, operators could still engage emergency response teams that may include police officers.

Some mental health activists, providers, researchers and the general public cautioned potential callers that national and local crisis hotlines maintain connections with 911, even if those ties are loose.

Mental health advocates aren’t suggesting people should avoid seeking help, but they envision a different system. "988 is not a panacea," said Jessie Roth, who directs the New York City-based mental health education nonprofit Institute for the Development of Human Arts.

But educators want people to “have informed consent (and understand) what is possible and what outcomes can happen that often do lead to more harm or trauma,” said Stefanie Lyn Kaufman-Mthimkhulu, who directs the Providence, Rhode Island-based mental health advocacy nonprofit Project LETS.

Fewer than 2% of calls to the 988 lifeline require an emergency response, said Dr. John Palmieri, the acting director of the 988 and Behavioral Health Crisis Coordination Office. Most are done with the caller's cooperation and consent.

Still, Black people who call BlackLine co-founder Vanessa Green often do not consider dialing the national hotline to avoid possible law enforcement interactions, she said.

Police encounters with historically marginalized people can “create unintended harms including violence, traumatization and criminalization,” according to minutes  from a meeting of the Individuals and Families with Lived Experience Committee the national lifeline assembled. A 2020 Prison Policy Initiative study and survey found police threatened or used force against Black and Latinx people twice as often as white people.

BlackLine’s national team of volunteer “listeners” connects Black, brown and Indigenous callers to local services whether they need housing, domestic violence shelters or medical attention.

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Rather than calling 911, Green employs her counseling background to identify the caller's possible triggers and talks them through their struggle. As BlackLine is not explicitly a suicide hotline, Green and other listeners handle few calls from people on the brink of taking their lives. If a person has already taken steps to end their life, Green helps them find someone who can take them to a hospital, or contacts the large network of providers she's connected with to find help. One pregnant woman texted Green several weeks after a call like this and thanked her for saving her and her baby’s lives.

According to 988’s website, the long-term vision includes “a robust crisis care response system across the country that links callers to community-based providers” like BlackLine or Trans Lifeline, a crisis hotline operated by and for transgender and nonbinary people. Trans Lifeline's former executive director sat on the Individuals and Families with Lived Experiences Committee.

“I have so much respect for the people that are working to create a system for support, and I do think that 988 is a really great opportunity to expand the resources available to people in need,” Trans Lifeline Director of Advocacy Yana Calou said. “If 988 would route to … alternative, community-based supports like ours, that would really go a long way to making sure that people get to speak with the person that they need.”

Callers may need someone who shares their identity and mindset. Green has previously shared the national lifeline number with people who phone BlackLine. People then call Green back because the national operator was not a person of color — they didn’t understand the callers’ lived experience.

“We just need someone who gets it,” Green said.

In some cases, if a caller first contacts 911, those dispatchers can dial a direct line to quickly reach the nearest crisis center. Goodwill of the Finger Lakes in Rochester, New York, maintains that relationship with 911 operators, said Deborah Turner, the organization’s Lifeline program director. Her staff contacts 911 as “an absolute last resort” and requires operators to get a supervisor’s approval before getting emergency teams involved.

“We have to make sure we’re following our no-harm policies,” Turner said. “The last thing we want is to send a police officer and break trust where they may not be at that level of high risk. We don’t want someone to be traumatized by that response.”

Similarly, operators at Resolve Crisis Services, a 988-affiliated hotline housed at University of Pittsburgh Medical Center Western Behavioral Health, do not “blindly or routinely” engage law enforcement in crisis calls, said Resolve Director Dr. Jack Rozel. He sat on the standards and practices committee that helped roll out 988, which discussed if and when police respond to mental health, substance use or suicide crisis calls.

Still, Rozel said, sometimes involuntary intervention, which can involve police or other first responders, may be necessary. In many situations, Turner said, a mobile crisis team consisting of mental health professionals may best serve a person in crisis. Such teams have been established in New York City, across the Empire State in Rochester, and in Allegheny County, Pennsylvania, where Resolve is located.

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Trans Lifeline operators also will not phone law enforcement to assist with crisis interventions unless a caller explicitly requests that, Calou said. They emphasize informed consent in their 40-hour training with operators, meaning they ensure that people are aware of what happens next once 911 gets involved.

Their policies and BlackLine’s also stand apart because they discourage operators from initiating a nonconsensual active rescue. That occurs when a person — in this case, a hotline operator — contacts emergency services without the person in crisis consenting, explained Emily Krebs. The Fordham University assistant professor has studied suicide since 2014. This type of rescue could involve police responding, which could lead to dangerous encounters between officers and suicidal people, Krebs said.

“People with actual or assumed mental illnesses die at the hands of police at high rates, especially when they’re also people of color, trans people, immigrants and/or members of other marginalized groups,” Krebs said. “For all of these reasons and more, many people avoid suicide hotlines due to very grounded fears of nonconsensual active rescue.”

Beyond 988’s affiliation with law enforcement, advocates fielded questions about geolocation after the number’s launch.

988 technology automatically routes callers to their nearest crisis center using phone numbers’ area codes. Area codes may not match where a person currently lives. For that reason, operators at 988, BlackLine and Trans Lifeline may ask callers where they live to connect them to emergency support or offer referrals. Callers do not need to disclose that personal information, according to Green, Calou and the 988 Suicide and Crisis Lifeline webpage.

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911 dispatchers, on the other hand, use geolocation to find callers' exact whereabouts. However, the Federal Communications Commission released a report at a 988 Geolocation Forum in May that considered the feasibility of an "automatic dispatchable location" with a hotline call. The agency’s findings recommended that Congress establish a “multi-stakeholder group” to study issues and consider next steps. The FCC was analyzing information gathered at the forum as of July 29, the 988 webpage reads.

The future of mental health response includes expanded financial support for community-based mental health teams and mobile crisis response groups, the 988 site says. In the meantime, smaller organizations including BlackLine and Trans Lifeline plan to continue helping their communities, and plan to grow with hopes of receiving more funding.

"I really see so much potential and opportunity (in 988)," said Calou, the Trans Lifeline advocacy director. "I just really want people to know what they're getting when they call and want us to think about who we can find to do this work."

If you or someone you know needs support for mental health, suicidal thoughts or substance abuse call, text or chat:

988 Suicide & Crisis Lifeline: 988 and 988lifeline.org

BlackLine: 800-604-5841 and callblackline.com

Trans Lifeline: 877-565-8860 and translifeline.org

Veterans Crisis Line: Dial 800-273-8255 and press 1 to talk to someone or send a text message to 838255 to connect with a VA responder. You can also start a confidential online chat session at Veterans Crisis Chat. veteranscrisisline.net

Follow Sammy Gibbons on Twitter: @sammykgibbons 

This article originally appeared on NorthJersey.com: 988 suicide hotline: What mental health activists are saying