988 Mental Health Hotline Failed to Boost Service Offerings

Rollout of the 988 suicide and crisis hotline in the United States has not led to significant and equitable growth in the availability of most mental health crisis services, except for a small increase in peer support services, a new study showed.

Emergency psychiatric walk-in services, mobile crisis response, and suicide prevention services all declined in the years since the new hotline was launched, investigators found.

“The lack of meaningful growth in most crisis services may limit the long-run success of 988, in particular, if callers feel that reaching out to 988 fails to result in access to appropriate sources of care,” lead author Jonathan Cantor, PhD, a policy researcher at RAND, Santa Monica, California, said in a statement. 

“Mental health officials and policymakers should consider strategies to boost the financing and availability of crisis services at mental health treatment facilities to meet increased demand generated by the 988 Suicide and Crisis Lifeline,” Cantor added.

The study was published online on January 29 in JAMA Psychiatry. 

Launched in July 2022, the 988 suicide and crisis lifeline provides a simple, easy-to-remember number (988) for people in a psychiatric crisis to call to get connected to a variety of mental health services. It replaced a longer national suicide prevention lifeline, which had people call 1-800-273-8255 (TALK).

Data have shown that launch of 988 prompted an increase in use of the lifeline. Specifically, 988 received roughly five million contacts in its first year, reflecting a 40% increase in call volume and a 1000% increase in text volume relative to the prior national suicide prevention lifeline. 

Cantor and colleagues examined trends in the availability of four crisis services offered before and about 1 year after the 988 rollout at 15,623 US mental health treatment facilities. The services were psychiatric emergency mobile and off-site services, psychiatric emergency walk-in services, suicide-prevention services and peer support services.

The largest changes were observed for peer support services — which increased from 39% before the 988 launch to 42% afterward (P P 

Public facilities, outpatient facilities, facilities that accepted Medicaid or private insurance, community mental health centers, federally certified community behavioral health clinics were all more likely to offer crisis services compared with their counterparts, the study team found. 

They also observed wide variation in the changes in crisis service availability across states. 

For mobile crisis services, the largest increase was observed in Kansas (14.5% increase), and the largest decrease was observed in Hawaii (23.0% decrease). For emergency psychiatric walk-in services, the largest increase was reported in Oklahoma (7.5% increase) and the largest decrease was in West Virginia (13.0% decrease).

In terms of suicide prevention services specifically, the largest increase in availability was seen in Montana (11.5% increase), and the largest decline in availability was in Rhode Island (11.4% decrease).

In contrast, most states experienced an increase in the number of facilities offering peer support services. The largest gain in offering of peer support services was in Kansas (19.6% increase), and the largest decline in peer support services was found in Georgia (3.2% decrease).

The accelerated growth in availability of peer support services after the launch of 988 could be due to an increase in the demand for such services over time or a part of a growing evidence base indicating the benefits of peer support for individuals in crisis, the authors said. 

“Although 988 has the potential to drive transformative changes in the crisis services treatment system, it requires robust financing and local treatment support to reach its full potential,” Cantor and colleagues concluded.

This research was supported by the National Institute of Mental Health. Cantor reported receiving personal fees from the Aspen Institute and Chestnut Health and grants from the National Institute on Aging outside the submitted work.