About 12 million adults seriously consider suicide each year. For those ages 10 to 34, suicide is the second most common cause of death. Substance use challenges, addictive behaviors, trauma and complicated grief often lead to tremendous despair and disruption for individuals, families and communities.
Recognizing these and other statistics, Congress passed the National Suicide Hotline Designation Act in 2020. The bill established means for a new, federally and state-funded network of suicide prevention centers that Americans could call with a 3-digit code: 988.
Now—after years of careful planning—the 988 Suicide and Crisis Lifeline launches nationwide on July 16, 2022.
Guest panelists from several areas of mental health advocacy joined Dr. Sally Spencer-Thomas on June 23, 2022 for an #ElevateTheConvo Twitter chat about the initiative.
What's So Special About 988?
Three elements of 988 make it an inspiring and potent tool for reducing suicide:
· Dedication to mental health emergencies
· Accessibility to all Americans
· Involvement from the most affected groups
Dedicated to Mental Health
The dialing code closely resembles the 911 code used for general emergencies. And, just like 911, the 988 code will be accessible anywhere and at any time.
However, 988 will answer the mental health, substance use, and suicide emergency calls that 911 responders have often struggled to respond to effectively. When people call the new number, they'll be rerouted to National Suicide Prevention Lifeline crisis centers, which has always supported many types of mental health emergencies – not just suicide.
The Lifeline will only call 911 (i.e., police, fire, and ambulance) services when there's an immediate threat to one's safety (e.g., they’ve already swallowed a life-threatening number of pills or they are holding a firearm). Responders will be able to gather more mental health context before the encounter, preventing misunderstandings and unnecessary violence. Violence that has often been disproportionally directed at BIPOC communities when police are called.
The Northwest Portland Area Indian Health Board (NPAIHB), an organization dedicated to reducing health disparities among Native Americans, reports that less than 3 percent of calls to The Lifeline will require 911 responders. The primary goal will be to develop a safety plan without involving law enforcement emergency services.
Accessible to All
Even crisis line workers and volunteers struggle with the 10-digit Lifeline number. "Been working on a crisis line for over two decades and still stumble over the 10-digit number when giving it out," says user @BelovedCrazie.
988 will be easier to remember, especially for those in severe psychological distress. But you'll still be able to call the original hotline at 1-800-273-8255 if you prefer.
And while the traditional National Suicide Prevention Lifeline lacks the capacity to cover both call and text services with one number, 988 will accept both texts** and calls.
**For now, 988 can only accept texts in English. Translation services will be available for calls.
Involvement from Affected Groups
What else is unique about 988? The involvement of groups most affected by suicide.
"We have been conducting listening-and-learning conversations with BIPOC, LGBTQ+, and other communities that have historically been inequitably unserved," says Babra Chakanyuka, an equity consultant for the Indiana Division of the 988 Crisis Response Team.
According to the CDC, one of these underserved communities is Native Americans, who "have the highest rates of suicide of any racial/ethnic group in the country."
They also tend to be younger: More than a third of Native Americans who died by suicide between 2003 and 2014 were 10 to 24 years old. In comparison, only 11 percent of white Americans who died by suicide were in this age group.
The trauma of forced removal from tribal lands, high rates of alcohol and substance use, poverty, and the suicides of loved ones contribute to disproportionate suicide rates.
Further, "Most Native American reservations lie in rural areas," says Maleah Nore, a Tlingit Alaska Native who works with the NPAIHB, WeRNative, and THRIVE Suicide Prevention Project. "This adversely affects access to health care, including mental health."
Only about half of Native Americans on reservations have high-speed internet, adds Nore, and around thirty percent lack phone service. Minimal access to these services restricts both in-person and tele-mental health care options for rural communities.
Native American youth who are also 2SLGBTQ+ (“Two Spirit”) are at the highest risk of suicide, and LGBTQ+ youth overall struggle more with mental health than their peers. The Trevor Project's 2022 National Survey on LGBTQ+ Youth Mental Health found that almost half had seriously considered suicide within the past year.
Transgender youth of color are also at an exceptionally elevated risk. Nearly 6 in 10 Black transgender or nonbinary youth had seriously thought about suicide within the previous year—more than a quarter had made an attempt in that time.
"Cultural competency will be part of the training for those working with the 988 lines," assures Dr. Patsy Evans, a mental health counselor and family court mediator. Advocates hope this training will further expand access to marginalized groups who otherwise feel excluded from mental health services because of race, sexual orientation, gender identity, spirituality, disability, or language.
Why Not Just Keep Using 911?
Frequently, law enforcement acts as the primary response to suicidal behaviors. But police officers aren't always trained to de-escalate such emergencies. Tactics often used to control criminal situations—such as yelling commands or threats—only aggravate mental health crises.
Too often, encounters between law enforcement and those experiencing suicidal crises end with law enforcement employing force—sometimes deadly—to terminate what they perceive as a public safety threat.
"A mental health crisis is not a criminal activity requiring uniformed police, marked cars, etc.," Sheryl Boswell of Youth Mental Health Canada says. Heather Kangas, a Baltimore LCSW-C, adds that she finds it disturbing how often youth come to the pediatric ER in handcuffs for a mental health crisis.
988 will ensure that those in psychological distress receive the care they need without the risk of escalating a mental health emergency.
Vision for the Future
Participants from the #ElevateTheConvo chat on 988 generally express optimism about the initiative.
"988 is an experiment, albeit one that will be hard to undo," says professor and founder/host of the Social Work Podcast Dr. Jonathan Singer. "Spending the time and energy to get it right is an ongoing task. Having the vision and leadership to ensure that 988 improves quality of life is key. All hands on deck."
The folks over at Youth Mental Health Canada hope the dialing code will ignite several more changes: "Community-based respite centers, compassionate responders who provide support and follow-up, optimal needs-based educational accommodations, and recognition of human and disability rights with action."
As a licensed clinician, DEI advocate, and crisis leader at RI International, Akemie Jones emphasizes that the Lifeline will need to employ people with the training to "de-escalate situations versus having situations that potentially end in violence or harm those in crisis."
Some also recommend vital policy changes to ensure the initiative's success, including taking better care of mental health workers and volunteers.
"We need to take better care of our workers," says Sarah Gaer, a trauma recovery specialist and suicide loss survivor. "Burnout causes poor care, and yet we do almost nothing to protect our people." Gaer suggests improved pay and expanded peer support as crucial elements.
Suicide Prevention Starts with Us
Crisis lines are irreplaceable services that, quite literally, save lives. Fortunately, though, we don't need to wait for our loved ones to experience a crisis before we intervene.
Preventing suicide starts with knowing what to look for. Several signs that can precede a suicide attempt include:
· Expressing a negative view of oneself
· Feeling like a burden on others
· Feeling trapped
· Hopelessness
· Isolation
· Aggression
· Irritability
· Drastic mood/behavior changes, such as reckless driving or risky sex
· Self-harm
· Substance misuse
· Frequently discussing death or suicide
· Giving valuable items away
· Threats of suicide
If you or someone you know needs urgent psychological support, consult with the following resources:
· National Suicide Prevention Lifeline: 1-800-273-8255
· Starting July 16, text or call 988 for mental health emergencies
· Crisis Text Line: Text HOME to 741741 or contact via WhatsApp
· Paths Remembered provides mental health services for 2SLGBTQ+ individuals: https://www.pathsremembered.org/mental-health-services/
· Trans Lifeline (https://translifeline.org): 1-877-565-8860 (U.S.)
· Trevor Project Lifeline: Call 866-488-7386, text START to 678678, or start a chat at https://www.thetrevorproject.org/get-help/
· Comprehensive list of mental health resources, including hotlines for mothers, those with addiction, and sex workers: https://linktr.ee/doctorharmony
Special thanks to the following guest panelists who joined the June 23 #ElevateTheConvo Twitter chat about 988:
· Dr. Jonathan Singer (@socworkpodcast)
· Babra Chakanyuka (@Babra_DC)
· Maleah Nore (@weRnative, @NPAIHB)
· Dr. Patsy Evans (@HarmonyUsInc)
· Diana Cortez Yanez (@DccortesYanez)
· Akemie Jones (@AkemieJones, @riinternatl)
· Judge Ginger Lerner-Wren (@judgewren)
