We’ve Had The 988 Crisis Line For a Year. Here’s What’s Working and What Needs to Change

On July 16 last year, the U.S. government changed the national suicide lifeline from an 800 number into an easier-to-remember three digit one: 988. As part of the revision, the government also pledged $1 billion to enhance services provided by the network, including building up staffing at the 200 call centers as well as creating more resources such as mobile crisis teams and crisis stabilization centers for people who needed immediate or follow-up care.

In the year since, the Department of Health and Human Services (HHS), the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), and the non-profit Vibrant Emotional Health—which together operate the 988 Suicide and Crisis Lifeline—say they’ve fielded more than 5 million requests from people in mental health crises via phone, text, and chat. That’s 2 million more than the previous iteration of the lifeline received in its last year. Not only is the Lifeline answering more requests, but those responses have become quicker as well, dropping from two minutes and 39 seconds prior to 988’s launch to just 41 seconds. The program has also expanded: the Lifeline recently added LGBTQ+-focused counselors and enhanced Spanish language services on phone, text, and chat. Counselors are trained to de-escalate a crisis, and if they aren’t able to do so, they have the ability to connect to the user’s local emergency medical services, including mobile mental health teams and emergency departments, which the program is also expanding.

The pandemic fueled a spike in mental health concerns, with the U.S. Centers for Disease Control and Prevention reporting that the share of Americans who experience anxiety or depression increased from 36.5% in 2020 to 41.5% in 2021, and those numbers continue to grow. The need for crisis care has become more urgent, especially among younger people, since more adolescents are reporting continued feelings of sadness and depression, as well as suicidal thoughts and attempts at suicide. While some states have effectively increased staffing at call centers, others continue to struggle to find and train enough counselors to provide the support their regions need.

HHS deputy secretary Andrea Palm and SAMHSA assistant secretary Miriam Delphin-Rittmon, both of whom helped to develop and continue to oversee 988, spoke to TIME exclusively about the program’s first year and their vision for what comes next.

TIME: Text requests to 988 have increased by 1,135% compared to the previous year, chats by 141%, and calls by 46%. Did you anticipate such an increase in demand for crisis help?

Delphin-Rittmon: We expected an increased uptake and requested funding from Congress to scale up the 200 call centers significantly to accommodate. We knew we would see that but still—and it’s breathtaking in its own way—it’s heartening to see this viable resource that people are connecting with when they are struggling. The increases in texts and chats largely reflects requests from young people who prefer those modalities, and we appreciate knowing that young people are reaching out to get the support and help that they need.

Over the past year, what gaps did you find in 988’s ability to provide support for people in crisis?

Delphin-Rittmon: We knew right out of the gate that it was important to not only have Spanish call centers but to also have text and chat in Spanish based on the volume of requests we saw coming in. So we’re thrilled to announce that we have staffed up across the country to take up Spanish chat and text.

We also launched an LGBTQ+ pilot a few months ago and we saw the volume come in there beyond what we anticipated, so we had to do extra staffing midway through. That will remain a consistent part of the call line—the ability for users to request a counselor specifically trained in issues relevant to the LGBTQ+ community.

How well can calls, text, and chat address people’s needs when they are experiencing a mental health crisis?

Delphin-Rittmon: What we’ve seen is that by and large, most people get to a place where they are feeling better by the end of the call. About 98% of people don’t need a mobile crisis team or an emergency department. Part of the next phase of the program is to expand and build out mobile crisis and support and to fund crisis stabilization centers.

Palm: For many people, 988 is the door in, and helps us to identify what care they may need next. The vast majority of people don’t need inpatient care or mobile crisis teams. But they might need a handoff to a mental health provider, a substance abuse counselor, or other services. That’s the next step in this program from my perspective: integrating needed mental health and substance-use services into the health care system so we are thinking about the whole health and wellness of the person.

There is no wrong door for people seeking help. Places like community health centers or primary care physicians can be cross-trained to help identify issues and connect people to care, and provide additional care if needed as well. Maximizing professionals we have in the field to do this work is also effective because we recognize the workforce shortages in health care more broadly.

What do the data on who used 988 over the last year tell you?

Delphin-Rittmon: When we look at the National Survey of Drug Use and Health data [from SAMHSA] it consistently show[s] that even prior to the pandemic, young people were struggling. Some 2021 data showed that for children 10 to 14 years and younger people 25 to 34 years, suicide was the second leading cause of death. Together with the 988 data, that increasingly lets us know that resources like 988 where young people can text or chat can make a difference in giving them an avenue and entryway to care, and connect them to services and support.

We have received additional funding for school-based training of teachers and others in the school setting to help identify young people who are struggling, and connect them to services and support. We have also [developed] mental health awareness programs at the community level, in churches, community centers, and with first responders to help identify people who are struggling with mental health or substance use challenges early on. And we have [built] an app for parents called Talk They Hear You to help parents start conversations about emotional experiences and substance use and helps them navigate resources and support services.