Millions use 988 mental health crisis line, but more training, resources could better reach people in need, researchers say

By Deidre McPhillips, CNN

(CNN) — The 988 Suicide and Crisis Lifeline has received millions of calls, texts and online messages since its launch in the summer of 2022, but a new study suggests that the mental health resource is far from reaching its full potential.

People with severe psychological distress were more likely than others to have heard of 988 and to have used the lifeline, according to research published Tuesday in JAMA Network Open. But overall, only a quarter of people said they would be very likely turn to 988 in the future if they or a loved one were experiencing a mental health crisis or suicidality – and less than a third of people with severe psychological distress who had already tried the lifeline were very likely to use it again.

“Launching the 988 hotline has been a critical step for addressing America’s expanding need for mental health services, but we have to get to the bottom of why so many users who were in serious distress wouldn’t use it again — whether that means better training is needed, more resources or other solutions,” said Michael A. Lindsey, dean of the New York University Silver School of Social Work and co-author of the new study.

The findings are based on a nationally-representative survey of about 5,000 people from June. Psychological distress was assessed based on self-reported responses to a standardized set of questions about feelings and experiences. Respondents were considered “very likely” to use the lifeline if they rated that likelihood at least 6 on a 7-point scale.

The 988 lifeline launched in July 2022, transitioning from the National Suicide Prevention Lifeline to a broader focus and a simpler dial code. Since then, 988 has received about 6.5 million calls, texts, and chats including more than 500,000 in September alone, according to data published by the US Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration. CNN has reached out to the agency for their perspective on the success of the lifeline beyond call volume metrics.

As the US faces a significant mental health crisis, experts emphasize how critical a tool like the 988 lifeline is. Monica Johnson, director of the 988 & Behavioral Health Crisis Coordinating office, has called it “the most transformative initiative in behavioral health care” that she’s seen in her decades-long career.

And the critical need makes it that much more important to get it right.

“By no means do I think our data should indicate failure,” said Jonathan Purtle, an associate professor at the New York University School of Global Public Health who led the new research. “We need this in this country and it’s a big deal. It’s very new and it’s reasonable that it’s going to take some time to get it really right.”

Success for the 988 lifeline would involve active management of acute crisis and help connecting people to broader mental health resources, he said.

“It’s active supportive listening, assessment and it’s a door to care. It’s a way into a system,” he said. “In an ideal world, success looks like getting all that on the call, but also getting follow-up care in a good supportive system once off the phone or done texting.”

Notably, additional analysis of the survey data also found that people experiencing psychological distress were less likely to reach out to other sources of mental health support, too, Purtle said – including psychologists, psychiatrists, friends and family members.

“988 interactions should leave people with a sense of hope and resources that they can access and benefit from. Successful interactions with the lifeline would be culturally competent and handled locally,” Lindsey said.

But getting it right on the lifeline – and after – will require better training of mental health professionals, the study authors said.

“Pre-988, the lifeline existed but marketed as the Suicide Prevention Lifeline for a much narrower type of caller,” Purtle said. “988 is a whole different animal. It’s more callers, a wide array of challenges, and one would argue, probably, that different types of training need to be in place to meet people where they’re at when they call.”

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