How does 988 work?

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Help for a mental health crisis is now just three digits away: 9-8-8.

Early data shows that people are increasingly contacting a national mental health hotline launched on July 16 as an easy-to-remember alternative to 911. But how does it work? And is it “friendly”?

The base

Rather than being referred to the police, callers (or texters) are connected to compassionate listeners trained to talk about crises ranging from suicidal thoughts to drug addiction. They can even advise people who are not in crisis, but hope to help a struggling friend. It is free and staffed around the clock.

“We want to make sure that we give people effective evidence-based care in a crisis, rather than giving them care that leads them to go through incarceration, hospitalization, emergency room visits time and time again, which has historically been how we’ve addressed the crisis in this country,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness.

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Before 988 went live, people seeking help had to call a 10-digit 800 number to reach the National Suicide Prevention Lifeline. Calls to that number — (800) 273-TALK — are still answered.

A bump in use

In August, the hotline’s first fully operational month, total volume — including calls, texts and chats — rose 45% nationwide, compared to the same month last year for the Lifeline, according to the U.S. Department of Health. and Human Services.

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Meanwhile, the average time it took for a response dropped year after year from 2½ minutes to 42 seconds. The Substance Abuse and Mental Health Services Administration, part of Health and Human Services, oversees the hotline.

Didi Hirsch Mental Health Services, which heads the crisis call for most of Southern California, said call volume doubled the day 988 went live.

The number has since fallen, but the West Los Angeles agency said total volume has increased by 27% on September 12 since its July launch. Texts shot up 176% and chats went down 20%. The number of calls has increased by 27%.

“This is a good thing. It means people are calling. They understand that 988 is here to help,” said Didi Hirsch Chief Executive Lyn Morris.

It sounds warm and fuzzy, but what about the fine print?

How do I access 988 services?

Anyone in the US can call or text 988. There is also an online chat option, 988lifeline.org/chat.

Didi Hirsch offers 24/7 English and Spanish-speaking crisis counselors. During peak hours, Korean speakers are available and there is support for the deaf and hard of hearing. Check the website, didihirsch.org, for details.

Who picks up or responds?

A crisis counselor trained in suicide prevention and coping with other mental health and substance use issues.

Where are the advisors?

988 calls are forwarded to the nearest crisis center that matches the caller’s area code.

For example, if you are calling from Los Angeles, but still have a number from your hometown in Pittsburgh, your call will likely be answered by someone in Pennsylvania first.

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If a local center is unable to respond, the call is automatically forwarded to a national backup center.

There are 200 call centers in the US. There are 13 such centers in California.

Will they know my location?

Unlike 911, calls to 988 do not use geolocation. That is, they do not trace the address or whereabouts of the caller.

In a 2021 report, the Federal Communications Commission examined the cost and feasibility of adding geolocation to 988 calls. Federal officials held a forum in May to discuss adding the feature. The information collected on the forum is reviewed.

Will the police show up if I call 988?

It depends. Most calls to 988 are resolved over the phone. However, 911 services can be overheard if the caller’s life is in immediate danger, such as an ongoing suicide attempt.

Morris said about 5% of the calls, texts and chats that Didi Hirsch receives require an emergency response. That’s equivalent to 6,850 of the approximately 137,000 contacts the agency received last year.

According to federal officials, the proportion drops to 2% nationally. That’s about 72,000 of the 3.6 million contacts Lifeline received last year.

The Los Angeles Police Department can forward calls to Didi Hirsch when the caller is experiencing a mental health crisis and is not a danger to themselves or others. Of the 5,000 calls routed to Didi Hirsch last year, Morris said, 82% were de-escalated by telephone. The remaining 18% were returned to the police.

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Who pays it?

The Biden administration spent $432 million improving call centers and related services. The government has asked for more money for the Lifeline in its annual budget. Congress has provided staff funding, and a mental health bill leaving the House would allocate more federal dollars to 988.

California leaders contributed $20 million to the hotline.

States are allowed to levy telecommunications fees to provide ongoing funding to 988, which is similar to how 911 is supported. A California bill that would add a monthly fee to every phone line as of January 1, 2023 is on Governor Gavin Newsom’s desk. The rate would remain at 8 cents per line until 2025, after which it may not exceed 30 cents per line.

What’s next?

“The transition to 988 is just the beginning,” Health and Human Services Secretary Xavier Becerra said in a statement.

The long-term vision for 988 is to reshape the national crisis response system. The Lifeline represents the first step, providing someone to call.

The architects of 988 envision a system that will also include someone to personally respond, such as mobile crisis teams, and go somewhere, including crisis stabilization programs.

“This is a work in progress,” Wesolowski said. “It will take many more years.”

Meanwhile, she said 988 saves lives.

“For people who may have suicidal thoughts or thoughts of harm, who may be in a different kind of crisis, having someone to talk to can make all the difference,” she said. “Knowing a 10-digit number is difficult under the best of circumstances. This is especially difficult when you are in a crisis.”

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