In First Year, 988 Crisis Line Represents a Step Forward, But Work Remains

The first anniversary of the new 988 Suicide and Crisis Lifeline already is upon us. During this past year, millions of words have been written about this phone number. Some have focused on the potential of a hoped-for future; others have emphasized the need to build key community infrastructure to support those who call. All agree that it represents a major step forward.

At this anniversary juncture, it is important for us to take stock. We need to assess what already has been accomplished and what next steps will be needed.

In May 2023, the total number of routed 988 contacts was 469,000, of which 67,000 were routed to the Veteran Crisis Line (see 988 Lifeline Performance Metrics | SAMHSA). These numbers can be compared to 361,000 and 52,000, respectively, for August 2022, the first full month of system operation. For both types of contact, the May 2023 numbers represent about a 30% increase over those for August 2022.

Of the 402,000 non-veteran contacts in May 2023, 65% were calls, 17% were chats, and 18% were texts. The percentage of calls actually answered and not abandoned was 89% in May 2023, up from 84% in August 2022. The comparable percentages for answered chats and texts were in the high 90s for both periods.

The reports coming from the field over the past 12 months have been quite divergent. Some have emphasized the fact that many calls to 988 are not, in fact, emergencies, but rather are calls to report a problem or concern with a social determinant, e.g., loss of housing. Other reports have expressed concern with the continued involvement of police in some jurisdictions. Still others have noted lack of coordination between 988 and earlier local call systems which still are operating. It would seem that many of these concerns are transitional and that they will be addressed over time.

Dr John Draper, a prominent figure in this work, noted that we finally have created a front door for a behavioral health emergency response system. He then went on to express his hope that our next efforts will involve building a house to go with this door. Clearly, this will include developing local capacity to staff mobile crisis response teams with peers and behavioral health professionals, developing diversion and other short-term crisis response centers, developing respite capacity, and linking this entire enterprise more closely to our intersectoral efforts to reduce involvement with the criminal justice system and emergency rooms.

SAMHSA funding for this effort has grown rapidly from slightly less than $25 million per year to slightly more than $500 million in FY23. We expect that this higher level of funding will continue during the Biden Administration.

Going forward, it seems very clear that we must improve system capacity at the local level for call responders, mobile crisis teams, and staff of short-term crisis services, particularly in rural areas and other areas with vulnerable populations. Because of our current behavioral health workforce crisis, this will be a challenging task. Efforts should be made to expand the use of peers, paraprofessionals, and suitably trained community members to conserve scarce professional personnel.

We also must enhance our efforts to move upstream to identify and address the social determinants of health that cause trauma, behavioral health conditions, and crises. Without doubt, it is always better to prevent a crisis rather than to address it later. As we develop our local crisis response staff, we need to ensure that they have appropriate training and skills, together with program structures, to do this essential upstream work.

Congratulations to all who have played such a significant role in developing and implementing the new 988 Suicide and Crisis Lifeline over the past year. All that you have accomplished is appreciated, and your continued achievements in the coming years are greatly anticipated.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.