There is now an alternative to dialing 911 for mental health needs. How is 988 Different than 911? Calling or texting these three numbers, “988,” will connect individuals to a local mental health crisis counselor for support. Federal Trade Commission set up the 988 Mental Health Crisis Hotline service to replace the National Suicide Prevention Lifeline with localized resources.
Whether the person is experiencing a suicidal crisis, mental health-related distress, or substance abuse situation, they will be connected to a mental health professional who is familiar with services in the respective local area to find the right people to assist.
“The switch to 988 improves access to care especially during urgent or emergency situations, such as during a suicide crisis. The PsychANP encourages naturopathic physicians to consider including 988 as one of the important resources in developing safety plans for our patients who are at risk for suicide or mental health crises,”
Alex Tan, ND, president of the Psychiatric Association of Naturopathic Physicians.
Prior to the 988 Hotline, the National Suicide Prevention Lifeline was just that—national. Federal, state, and local organizers of 988 recognized the limitations of a national service because mental health issues are best addressed in the community where one lives.
Veterans can press “1” after dialing 988 to connect directly to the Veterans Crisis Lifeline. For texts, Veterans should continue to text the Veterans Crisis Lifeline shortcode: 838255.
The National 1.800.273.TALK (8255) number for the National Suicide Prevention Lifeline will continue to operate indefinitely. The only time someone might be connected to the National Suicide Prevention Lifeline from 988 is if there is a backlog in a local area.
Is 988 Different from 911?
The 988 Suicide and Crisis Lifeline does not connect the user to the local police. Instead, there is a network of more than 200 crisis centers with experienced mental-health experts available to help individuals overcome crises. These centers are supported by local, regional and state counselors. They have the backing of the Substance and Mental Health Services Administration (SAMHSA)—an agency of the Department of Health and Human Services. the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA). Calls and texts can be made 24/7 for confidential support in suicidal crises, mental health-related distress, or substance abuse situations.
“PsychANP believes that primary care providers, including naturopathic physicians, should have basic competency in suicide risk screening, assessment and appropriate interventions. 988 is one of the important and accessible resources in developing safety plans for our clients when appropriate. For example, low to moderate suicide risk patients may be recommended to reach out to 988 as a resource when needed as part of a comprehensive suicide safety plan, while high risk suicide risk patients should be referred to a mobile crisis unit, 911, 988, or the ER depending on the specific infrastructure of care in a city or state. Naturopathic physicians, who are trained as primary care providers, can help provide mental health care to the level of their training and scope of practice,”
Alex Tan, ND, president of the Psychiatric Association of Naturopathic Physicians.
Additional facts about 988 Mental Health Crisis Hotline
- Though the mental health support comes from local individuals, 988 does not geolocate like an emergency 911 call. It will not find a person to send emergency help.
- The planners behind 988 considered that law enforcement may not always be the appropriate response team for mental health crises. History shows a disproportionate amount of trauma for individuals who entered the criminal justice system or psychiatric holdings in hospitals and emergency rooms for mental health issues. The unintended consequences created a great deal of mistrust and stigma around mental health. The 988 hotlines are designed to overcome some of this systemic dysfunction through warm communication from crisis counselors who are trained to determine the type of care needed.
- Though there is a high death by suicide rate in this country (see below), about 2% are acute situations, explained Brooke Briggance, with the Cypress Resilience Project (on a web forum Aug. 2022 about the new 988 service). The remaining 98% are thoughts of suicide with no intent to take action. The 988 mental health experts are trained to de-escalate the crisis, help the caller establish a mental health safety plan process, direct them to the right people for care and provide follow-up, said Briggance.
Limitations of 988
The 988 system was designed to provide alternatives to 911. However, if the 988 counselor establishes that a 911 call is necessary, they will facilitate that action. The Substance Abuse and Mental Health Services Administration (SAMHSA) is encouraging all fire and law enforcement to continue training in cross-system collaboration with 988 and other community mental health providers so people can get the appropriate type of help that is needed. (here is an example of what police are being told about 988).
Overdoses are probably the most visible example of a limitation of 988. Since the system does not geolocate, if someone overdoses from heroin, morphine, fentanyl, or oxycodone and the reverse-drug naloxone is onsite, the 988 counselors can guide the person or witness through the process. But needless to say, they cannot administer it by phone or text, nor can they geolocate to find the person.
The situation may require an in-person mental wellness check depending on the regional or local system that may be law enforcement, or it could be an EMT or other local mental health crisis expert. Briggance said there is a need for more mobile mental health units that can facilitate an in-person mental health wellness check and determine the type of care that is needed.
It’s not perfect, but the 988 Suicide and Crisis Lifeline is an improvement over the previous system of engaging with law enforcement for something they are not always adequately trained to address. This easy-to-remember 988 number will allow individuals in crisis to get the help they need and decrease the stigma surrounding mental health and substance abuse issues.
Suicide Facts from the American Foundation for Suicide Prevention
Facts About Suicide
- Suicide is the 12th leading cause of death in this country, with 130 per day.
- In 2020, 45,979 people died from suicide with 1.20 million attempts.
- The rate of suicide is highest in middle-aged white men.
- Firearms account for 52.83% of all suicide deaths.
In 2020, the suicide rates were higher among adults ages 25 to 34 years (18.35 per 100,000) and 75 to 84 years (18.43 per 100,000), with the rate highest among adults ages 85 years or older (20.86 per 100,000). Younger groups have had consistently lower suicide rates than middle-aged and older adults. In 2020, adolescents and young adults aged 15 to 24 had a suicide rate of 14.24.
