Who Is Using The 988 Crisis Line?

The National Suicide and Crisis Lifeline — 988 — launched on this day exactly three years ago. People who call the line seeking support are connected to a local network of crisis centers and a trained crisis counselor. And while millions of people have contacted the line since its launch, a new study https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2835119shows portions of the country still don't know about it. Short Wave host Emily Kwong https://www.npr.org/people/767284140/emily-kwong speaks to Jonathan Purtle https://publichealth.nyu.edu/faculty/jonathan-purtle, one of the lead researchers of on this study, about the findings, how the hotline differs from 911 and what its existence signals to Americans. Want us to cover more mental health news? Tell us by emailing [email protected] mailto:[email protected]! We'd love to know what you want to hear from us! Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 0:00Speaker 00

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• 0:19Emily Kwong?

  You're listening to Short Wave from NPR.

• 0:24Emily Kwong?

  A few years ago, I started seeing these signs posted all over my city, in the metro, in public places, sharing this three-digit phone number, 988. That is the National Suicide and Crisis Lifeline. And it was launched on this day, exactly three years ago. When you call the line,

• 0:45Speaker 02

  You've reached the 988 Suicide and Crisis Lifeline.

• 0:48Emily Kwong?

  The first thing you hear is a prerecorded message.

• 0:51Speaker 02

  Para español, marque el número dos.

• 0:53Emily Kwong?

  With options to connect to specialized support for populations at high risk of suicide.

• 0:59Speaker 02

  If you are a veteran or service member or are calling about one, press 1. To connect to support for LGBTQI-plus youth and young adults, press 3.

• 1:10Emily Kwong?

  Last month, the Trump administration announced it was canceling funding for a 988's LGBTQI-plus service. That service alone has received over a million contacts.

• 1:21Speaker 02

  Otherwise, to talk with a counselor, stay on the line or press 0.

• 1:25Emily Kwong?

  And then what happens is that, using nearby cellphone towers, the system routes your call through an existing network of 200 local and state-funded crisis centers and connects you to a trained crisis counselor who works in your area. That person picks up the phone and listens.

• 1:45Emily Kwong?

  Since launch, the line has been contacted millions of times, through calls, texts, and the 988 chat box. And a new study led by researchers at NYU and Johns Hopkins estimates that 1.6% of the US population used the line between July of 2022 and December of 2024.

• 2:05Speaker 03

  Picture a room, 50 people. That's one of them.

• 2:08Emily Kwong?

  This is lead author Jonathan Purtle, an associate professor at NYU who researches how mental health policies are implemented. And while 988 may look successful on paper, he says the percentage belies just how many Americans are in need of mental health support.

• 2:25Speaker 03

  It's still half the rate of emergency department use for mental health issues, which I think when we look at the data that way, it's an indicator of there still continues to be a lot of room for 988 use to grow and meet what is the demand out there.

• 2:40Emily Kwong?

  Today on the show, we talk about how 988 is going, three years out, what it offers in addition to 911, and why portions of the country still don't know about it. I'm Emily Kwong, and you're listening to Short Wave, the science podcast from NPR.

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• 4:04Emily Kwong?

  All right, Jonathan, so before we dig into your findings about who has and who has not been using 988, I want to talk about 911. A previous generation, you know, my parents, myself, too, was taught to call 911 for any crisis, including a mental health crisis. How is a call to 988 for those crises different?

• 4:24Speaker 03

  Yeah, 988 is part of a broader crisis continuum, right? So these are people who are trained specifically to deal with mental health crises. The 988 counselors will almost surely be familiar with those services and those teams. They may be able to deploy those teams to you directly and stay on the phone with you while those teams are on their way. So sure, in some places, somebody would call 911 and perhaps that 911 center knows about a mobile crisis response team in that same region and they deploy that team as opposed to just deploying ambulance or police.

• 5:05Speaker 03

  I think in general, 988 centers have a much richer knowledge and better relationships with mobile crisis response teams and other kind of alternative response models, as they're called, that can be deployed. Whereas folks in 911 centers might have less knowledge about those services.

• 5:25Emily Kwong?

  And you and your colleagues, you set out to determine a number of questions related to who was calling 988. And I want to talk to you about the piece you published in the journal JAMA Network Open, where during a 30-month period, you found more than 16 million calls, texts, and chats reached 988. And one finding that stood out to us was just the fact that 11% of the contacts came from veterans who were then transferred to the Veterans Crisis Line. Do you have any further comment about the fact that 11% of the contacts were from veterans?

• 5:58Speaker 03

  I think, you know, I think it can be perceived as a positive finding. You know, the Veterans Crisis Line had existed for a while, but I think, you know, the public-facing communication and marketing about the Veterans Crisis Line, probably not as intense as the communications about 988. So there are probably many veterans who didn't really know about the Veterans Crisis Line and learned about 988 and felt in crisis and called and were very pleasantly surprised, perhaps, to hear that option for pressing 1.

• 6:30Emily Kwong?

  And looking at the data, you found geographic differences, too?

• 6:34Speaker 03

  Yeah.

• 6:35Emily Kwong?

  That some places in the US were using 988 more than others. What did you find?

• 6:39Speaker 03

  Yeah, healthcare in general, but I would say especially mental health care and policy is very state-driven in the United States. And within some states, there is also a lot, it's county-driven, right? So then we have county variation within states. So we found that rates of 988 use were much lower in the southern parts of the United States. So when we ranked, you know, all the states in terms of their, their rate of 988 use, really big states like Florida and Texas were down there like at the very bottom, which I think is, is, is kind of troubling because these are major population centers in the US where a ton of people live. And we don't really know the why from our data, but we can speculate.

• 7:24Speaker 03

  In, in prior work and work of others, we found that more conservative folks generally report in survey-based work, being less likely to use something like 988 and being less supportive of it. It might be a matter of values and a matter of experience that in more conservative parts of the US, there might be more skepticism towards mental health treatment and counselors in general.

• 7:55Emily Kwong?

  Yeah. Now, you did a really interesting second study that was published in Health Affairs. You and a team surveyed 5,000 adults about mental health support. How did you go about collecting data about the types of support people are more likely to use, which includes 988 for some, but, but for others does not?

• 8:15Speaker 03

  So what we did, we asked these 5,000 US adults, so we fielded this survey back in 2023. So it was one, pretty much exactly one year after 988 launched. And we presented people with the question of if you or a loved one were experiencing suicidality or a mental health crisis, how likely would you be to turn to each one of these sources? And we listed five sources. 988, which we defined for them briefly in the survey, a crisis line other than 988, a mental health professional, like a psychologist or a social worker or psychiatrist, a friend or a family member, or someone in your religious network, right? So we asked them this question and we had them rate these things on a seven-point Likert scale. So if you say one or two, you probably have like

• 9:00Speaker 03

  strong feelings that like, no, I'm not going to turn there. And then on the other side, we'd dichotomize if people said six or seven. So if you said six or seven on the scale, you probably might actually turn there in a crisis. Right? We found these five different groups that varied in terms of where they would turn, or they say that they would turn in a crisis.

• 9:21Emily Kwong?

  And what were those five types of groups?

• 9:22Speaker 03

  So we had this group that we called Seek Help Nowhere. We had this group we called Definitely Not 988, Yes, Friends and Family Distressed. A group we called Seek Help Everywhere. A group we called Seek Help Most Places, But Not Religious Network. And finally, a group we called Relatively Indifferent, Not Distressed.

• 9:42Emily Kwong?

  I found it interesting that the Definitely Not 988, but Yes, Friends and Family, distress group had the highest levels of recent psychological distress. Why is that?

• 9:52Speaker 03

  Yeah, so I think that's one of the most important findings of the study. So people in this group, Definitely Not 988, Yes, Friends and Family Distressed, they had the highest proportion of folks that had serious psychological distress in the past 30 days. And just kind of bring this back to 988. 0% of the people in this group said that they would be very likely to turn to 988 in a crisis. And 95% said, no, I definitely would not, which is one or two on this scale. We did find this group also had significantly less awareness of 988, which also has implications.

• 10:35Speaker 03

  So I think this raises, you know, thinking about marketing communication about 988, you know, arguably, one may say, these folks who are experiencing, you know, poor mental health in the past 30 days, this is a group we really want to know about 988 and feel comfortable potentially contacting 988. And we're kind of seeing the opposite here in these data, which I think is implications for how we disseminate messages and the content of those messages that we craft.

• 11:01Emily Kwong?

  Mm hmm. Well, let's talk also about the fact that the Trump administration has cut funding to the LGBTQI-plus youth service of the line. That is set to go away on Thursday, July 17. Once that option goes away, what kind of specialized mental health support will still exist for LGBTQI plus young people?

• 11:22Speaker 03

  I think the silver lining is, you know, pre 988, the Trevor Project has existed and will continue to exist. And they, you know, have funding from other sources as well that will remain an option.

• 11:37Emily Kwong?

  Right. And for anyone who doesn't know, the Trevor Project was one of the groups providing 24/7 support for 988's LGBTQI plus callers. They handled about half of the contacts from this group of people. So zooming back out, just as we close, what message do you think it sends that 988 does exist? What does it do?

• 11:57Speaker 03

  Yeah, no, I think it does a few things. I mean, one, I think it it normalizes the fact that humans experience feelings of crisis and suicidality and that, you know, the federal government supports this this lifeline or the safety net, sends a positive message of of normalizing that and ideally normalizing help seeking as well, which I think is, which I think is, is really, really powerful and very positive. I guess I think it's really important to keep in mind, though, you know, it is, I would say, the category of necessary but not sufficient, right?

• 12:37Speaker 03

  We need a mental health system more broadly beyond just call, text and chat. We need a workforce which is, you know, paid well enough to to stay in their jobs, to have a public mental health system with capacity to see people who need, who need care.

• 12:58Emily Kwong?

  Well, thank you so much for talking to me about, about 988 and what it means to people around the country.

• 13:06Speaker 03

  Yeah, thank you for having me.

• 13:11Emily Kwong?

  This episode was produced by Rachel Carlson. It was edited by Rebecca Ramirez and fact-checked by Tyler Jones. Robert Rodriguez was the audio engineer. Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy. I'm Emily Kwong, and you're listening to Short Wave, the science podcast from NPR.

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