988 Lifeline: Crisis Care That Feels Like Care

One year ago, we embarked on a momentous effort to strengthen the continuum of behavioral health crisis care across the country. With the launch of the 988 Suicide & Crisis Lifeline, our national network of crisis centers transitioned to a three-digit number and gave communities an unprecedented chance to invest in crisis response. This historic launch is an opportunity to dramatically shift how behavioral health care is perceived and accessed, by anyone, anytime, anywhere—and that journey has only just begun.

Too often, people in crisis have been met with delay, detainment, and even denial of services, making them feel punished or cast aside, adding to their trauma. Now, 988 is serving as a new lifeline for many in moments that could be their worst. Since its launch in July 2022, the 988 Lifeline has fielded an increased volume of calls, texts, and chats and significantly increased response times across all forms of contact. It has also expanded its specialized services, with the Veterans Crisis Line experiencing record volume, new 24/7 counseling for LGBTQI+ youth, and efforts tailored for Indian Country.

Beyond these performance metrics, the 988 Lifeline has sought to improve the experience of its crisis care, to provide care that feels like care. It aims to help people get through a moment of crisis so that they can get back to their lives and dreams. This goal requires national changes to how hospitals and law enforcement engage in behavioral health crises, such as only involving police in issues of threats to public safety. These changes will allow hospitals and law enforcement to get back to what they are best at—medical care and public safety. 

In the last year, still just less than half of the United States has comprehensive or partial 988 legislation enacted or pending. This can be for many reasons, but we need to overcome these barriers to have 988 come to its full fruition to increase timely access to behavioral health crisis care.

While increasing the accessibility and quality of crisis services have been critical aims of the 988 Lifeline, increasing the public’s awareness of it has been equally key. Leading up to and after the Lifeline’s transition to 988, we have seen coordinated communication initiatives among partners in our field, supported by the development of resources such as the 988 Messaging Framework and Partner Toolkit. There have also been creative state and local marketing efforts to help raise awareness about 988 services. In addition, there are efforts underway to better understand the needs of groups at high risk for suicide to help inform future 988 messaging and services.

Continuing to build on these outreach efforts is critical, with recent data suggesting there is ample opportunity. The effectiveness of a standard number relies on the public being aware of what it is and when to use it. Some of those surveyed indicated concerns about using 988 for fear of law enforcement being sent, forced hospital stays, loss of confidentiality, cost of services, or incarceration. Future messaging should address these concerns so that not only is the public aware of the existence of 988 but trust that it’s safe to reach out to for support. Communication efforts should also use platforms and messengers that are trusted by communities to help decrease barriers to accessing care.

Partnering across all levels of the public and private sector can help us innovate and expand 988 messaging to reach people where they’re at. In a recent 988 Crisis Jam episode, mental health leaders from Google and YouTube presented their efforts to meet the global rising need for mental health content. To help support people throughout their mental health journeys, these tech giants have focused on providing both authoritative information and lived experience stories, highlighting a state of well-being and traditional medical models as a dual continuum guide for mental health product development.

We have come a long way since the launch of the 988 Lifeline one year ago, but our journey to transform our crisis response systems has only just begun. Now is the time to build on that progress, continue to strengthen our crisis care continuums, and ultimately save more lives. The development of the 988 Lifeline requires a push for 988 legislation and further funding across the U.S. as well as implementation of the core services needed to ensure every person in crisis has someone to call, someone to come, and a safe place to go.

David W. Covington, LPC, MBA

CEO and President, RI International 

Partner, Behavioral Health Link

Five Lanes Crisis Partners

Member, SPRC Steering Committee