One year later: What’s working and what’s not with the 988 Suicide & Crisis Lifeline

The mental health center in Houston is a good example of how the 988 Suicide & Crisis Lifeline is faring across the nation.

Staffers such as Jennifer Battle and others have responded to more than 52,000 crisis calls from local Texans in the past 12 months alone. That's an 80% pickup rate, up from 45% under the old system before it was revamped by the federal government in 2022.

It's not a perfect system, Battle says. But the progress in the past year has been "extraordinary," especially since the number of calls has grown exponentially. The state has the third-highest call volume, behind only California and New York, she said.

The Biden administration through the Substance Abuse and Mental Health Services Administration one year ago launched the 988 phone number to replace an old 10-digit number. Since the launch, hotline responders have answered a majority, but not all, of the 5 million calls, chats and texts messages they received.

A 988 call is for a different flavor of emergency and brings a different focus of help than 911. The 988 call center offers 24/7 call, text and chat access to trained crisis counselors who can help people experiencing suicidal thoughts, substance abuse, mental health struggles or other kinds of emotional distress, federal officials say.

The 911 system focuses on dispatching emergency medical services, firefighting response and police. Only a small percentage of 988 Lifeline calls requires activation of the 911 system.

Suicide, depression and anxiety grew in record numbers during the coronavirus pandemic, several pieces of research show, and the administration wanted to create a simple way for Americans to reach out for help amid the growing need.

The Biden administration initially invested in the hotline with $1 billion in spending to ramp up services and has continued to fund it. The Department of Health and Human Services in May announced an additional $200 million for the crisis line in part to help states speed response times, "ensure access to culturally competent 988 crisis center support" and improve follow-up services.

“Our nation’s transition to 988 moves us closer to better serving the crisis care needs of people across America,” said Xavier Becerra, secretary for the U.S. Department of Health and Human Services, at the time. "988 won't be a busy signal, and 988 won't put you on hold. You will get help."

Battle, vice president of community access and engagement at the Harris Center for Mental Health and Intellectual and Developmental Disabilities, said she's ecstatic about the progress, but there's room for improvement.

Staff at the Harris Center haven't been able to pick up some of the hotline calls because of the lack of resources, and people who call in are directed to the service closest to their phone number's area code instead of their exact location, for example.

Mental health experts, state and local providers and Americans who have used the suicide and crisis hotline have shared both the ups and downs of the hotline.

Service providers told USA TODAY the crisis line has a long way to go before it becomes as efficient as 911 and will need more staffing and funding to get there, but they said it's a good starting point. They said the hotline has provided an efficient way for people to talk to a trained professional when they're in crisis, offering those in need like young people and veterans a route to ask for help.

Other Americans who have used or have been hesitant to use the hotline have said on social media that mistrust in the service persists, particularly those who fear police involvement. Some have said it saved them in a time of need.

What’s working with the 988 Suicide & Crisis Lifeline?

The 988 Suicide & Crisis Lifeline has received more than 5 million phone calls and texts since its launch in the summer of 2022, according to data from the Substance Abuse and Mental Health Services Administration.

Of 402,494 calls, texts and chats the hotline received in May 2023, for example, responders answered 89% of calls, 98% of chats and 93% of texts. In July 2022, responders received 354,625 requests for help and answered 83% of calls, 82% of chats and 94% of texts.

“Data continues to show an increase in overall calls, texts and chats from the year prior, and at the same time, answer rates are significantly improving, which means that more people are getting help and they are getting help more quickly, which is crucial for someone in crisis," said Miriam E. Delphin-Rittmon, an assistant secretary for mental health and substance use at the Department of Health and Human Services and the leader of the Substance Abuse and Mental Health Services Administration.

Of all calls to the hotline in the past year, the department estimates that almost 1 million, or one-fifth of them were answered by Veterans Crisis Line, which is linked to the 988 Lifeline.

“There is nothing more important to VA than preventing veteran suicide – and that means getting veterans the support they need, exactly when they need it,” said Denis McDonough, secretary of the Department of Veterans Affairs.

The Department of Health and Human Services announced Thursday that it had added Spanish text and chat services to the existing hotline. Earlier this month, that department expanded "specialized services" for LGBTQ youth people, which were recently added to the list of services offered through the hotline.

Ashley Peña, an executive director of Mission Connection, an intensive outpatient telehealth program, said the hotline "has been a game changer" particularly for young people because of the texting option it offers.

"We have individuals we serve that use it sometimes weekly," she said. "It's really been powerful for that age group."

What's not working with the hotline?

Mistrust in the hotline, particularly in communities where mental health is stigmatized, still exists, said Peña, and breaking that down is crucial for the success of the hotline.

Some people are worried about responders calling local police on them for expressing suicidal ideation or even being forced into a psychiatric hospital, she said.

On Thursday, The National Alliance for Mental Health released the results of a study that shows "58% of Americans somewhat trust, and 22% have a great deal of trust, that 988 would provide them with the help they need − even if they are not personally familiar with it or know anyone who has contacted the Lifeline."

Some suggestions that providers and people who have used the hotline have said it could improve include:

• Improving the location to which the hotline directs Americans calling in to better align with where they are. The hotline directs someone who calls to the nearest affiliated provider to the area code a person is calling from. If someone has an area code different from the area they're living in, responders will have to connect that person with more local information. It's a barrier, Battle said, because it adds an extra step that some callers may not be willing to wait on.

• Investing in more staffing and improving the workforce so qualified responders can quickly and efficiently answer all phone calls.

• Granting providers permanent funding for the program in part to account for callers who may not have insurance to cover the mental health support, including therapy, Peña said.

• Increasing awareness about the resource, Peña said. The research from National Alliance on Mental Health shows "less than 1 in 5 people are somewhat or very familiar" with the crisis line.

How does the mental health of Americans fare?

Rates of suicide, depression and anxiety grew during the pandemic, and they have persisted. Young people are especially at risk. A new report from the National Institute of Mental Health shows suicide rates among young people increased during the pandemic, and it's the "leading cause of death among young people in the United States."

The Centers for Disease Control and Prevention found that teen girls experienced more sadness, violence and suicide risk in 2021 than in years before. Another study from the group from 2021 shows suicide was the second-leading cause of death for people ages 10 to 14 and 25 to 34.

Recent data from a national survey by the Substance Abuse and Mental Health Services Administration shows about 12.3 million people ages 18 or older, or 4.8%, "had serious thoughts of suicide. About 3.3 million young people ages 12 to 17, or 12.7%, had similar thoughts.

Disparities widening: Suicide rates increase after 2 years of decline

CDC survey finds: Teen girls report record levels of violence, sadness and suicide risk

Contact Kayla Jimenez at kjimenez@usatoday.com. Follow her on Twitter at @kaylajjimenez.

This article originally appeared on USA TODAY: One year later: 988 hotline has received 5 million calls, texts