The 988 Hotline: Three Years In

welcome to Mental Health Evolution, a podcast about what's changing in mental health and why it matters. I'm your host, Rachel Harrison, inviting you into honest conversations with people from all perspectives in the field. Clinicians, tech founders, investors, insurance companies, and all the folks in between. Let's explore what's working, what's not, and what's next.

Welcome back to the Mental Health Evolution Podcast, where we explore changes happening in the mental health industry and discuss topics from multiple perspectives. Today I want to take an honest look at something that touches all of us in the mental health field, whether we work in direct care, run a practice, or think about systems and policy. And that is the 988 Suicide and Crisis Lifeline. It launched in July 2022, replacing the previous 10 digit National Suicide Prevention Lifeline number, and the shift was more significant than just a shorter number to remember. The underlying network of crisis centers is largely the same, but 988 came with expanded access, new infrastructure and a broader mandate. Text and chat capacity increased dramatically, specialized routing was added for veterans and Spanish speaking callers. And Perhaps most importantly, 988 was explicitly designed to function as an alternative to 911 for mental health crises, recognizing that a law enforcement response is often not what someone in a mental health emergency actually needs. Call centers in Massachusetts reported a 30% increase in contacts within the first year and attributing it to directly to the easier number and surrounding public awareness efforts. So the name change matters. Even if counselors answering were already there nearly three years in, it's worth asking is this actually working? Where has it made a real difference? Where are gaps and what still needs to happen systemically for it to fulfill its promise. I also want to be transparent that this episode is also groundwork for an upcoming conversation we have on virtual crisis teams and I think understanding where 988 stands right now will make that discussion much richer. So consider this context setting for what is coming. This episode will provide an overview of what 988 is doing well, where the data reveals gaps and how funding and equity concerns are shaping outcomes, and what the next chapter of Crisis Care really needs to look like. As always, there are a few articles that I want to provide in case you want to dive deeper into this and of set the stage for the conversation today. The first one is called About 988. It's published by the 988 Lifeline and it is the official overview of how it came to be and what changed in the transition from the national suicide prevention lifeline and how the system is currently structured. The next article is called New Data Exposed Critical care gaps in 988 crisis lifeline, and this is published by AG AJMC. It covers a 2025 study published in the Journal of American Medical Association Network Open, examining all contracts to 988 since launching through the end of 2024, including regional disparities and lower than expected usage in the South. Next Article 988Mental Health Crisis Line evolves nationally and states seek stable funding and this piece is published by the Georgetown center for Children and Families covering major recent developments, including the rollout of GEO routing and the discontinuation of the LGBTQ specialized line that used to be there, along with the Veterans line and the Spanish speaking line, and how states are working to build more sustainable funding structures. Lastly is an article called 988 Evolution and the next Chapter in Crisis Care, published by the Institute for Crisis Mental Health and Grief Leadership and Treatment, and this piece focuses on what is to come next and the gap between the call itself and what happens next. So let's dive into this conversation a little bit more. I want to start by talking about what 988 actually is. I think there's a little bit of confusion there sometimes about what happens when somebody calls. So when someone dials, texts or chats, they are connected to a trained crisis counselor through a network of over 200 locally operated crisis centers around the country. The system is overseen by SAMHSA and administered by Vibrant Emotional Health. It is available 24 hours a day, seven days a week, and it is free and confidential. It also specializes routing for veterans who can press 1 to reach the Veterans Crisis Line as well as Spanish Lang. The idea was to make crisis support as easy to remember and access as 91 1, and in a lot of ways that simplicity has made a difference. So let's start with what the data actually shows, because there's some good news here. Since launching, 988 has handled over 16 million calls, texts and chats. That's great. The monthly contact volume has grown dramatically, and by May 2024 the system was fielding more than half a million contacts per month. That is an 80% increase from where it started. Answer times are also getting better. During the previous Lifeline era, the average wait time was about 140 seconds. By early 2024, the wait time had dropped to about 21 seconds. The in state answer rate, which measures the percentage of calls answered by a center in the caller's own state reached an average of 85%. These are improvements and reflect investment and growth in the system. There's also growing public awareness. A NAMI and I POSIS poll post published in July 2025 found that 74% of Americans are now aware of 988, up from 44% shortly after launch. That growth matters because people cannot use a resource that they're not aware of. So these are all the good news. I would add too that 988 provides a great support for people operating in the mental health care industry. To be able to have something that provides 24 hour assistance and care and availability is a great support, especially in outpatient intensive outpatient environments where a client or patient might have a crisis. And to know that there's support in place and a way for them to access a person greatly enriches the stability and the accessibility for clients. But there are some gaps and I think it's good to talk a little bit about these two. Awareness about 988 is not evenly distributed. While overall awareness has grown, it remains significantly lower among black, Hispanic and Asian adults and among people who do not speak English as a primary language. Research has also shown that communities in the south consistently have lower contact rates with 988. A 2025 study in JAMA Network Open found that the south had the lowest contact rates nationally and that funding levels and political dynamics in some region may be contributing to that gap. A line that is unequally known about and unequally funded will produce unequal outcomes. And that is a system problem for sure. Second, in state, answer rates vary enormously from state to State. In May 2024, some states were answering 97% of calls in state, while others were as low as 64%. And I think the big deal there is that when a call is not answered in state, it goes to the national backup center. It's great that there's still a person on the line that's a strength, but I think some of the failure may be that that person may be talking to someone who doesn't know their community, their local resour resources or specific things about their state such as crisis resources and things like that. Third, the question of what happens after the call remains largely unanswered. At a Systems level, a 988 crisis counselor can de escalate, provide support and share resources. What they cannot guarantee is that the person will have access to care tomorrow or next week. So follow up calls are identified as a Best practice and research definitely supports their effectiveness. But follow up is not universally offered, it is not standardized, and it is not systemically connected to what comes next in the care continuum. The founding executive director of the National Suicide Prevention Lifeline, who helped build the foundation for 988, has written compellingly about this. He says, we built a strong front door and now we have to build what comes after it. That means mobile crisis teams that can respond in person when a call is not enough, and crisis stabilization facilities where someone can go when they are not safe enough to be alone but do not need inpatient hospitalization. The question of being able to answer that urgent call is great, but if we can't follow up, we're leaving people safe, certainly in a lurch. What do we do next? And this is an important question that I think every community needs to begin to address. Some communities have done this. Mobile crisis definitely exists in a lot of places. Hospital emergency rooms can't necessarily always be the place for this and can be long waits and may not get the care that someone needs. The next question is always the funding, the money. That's a thread that runs through every gap in the 988 system. 988 is funded through a patchwork of federal grants and state level appropriations, and that patchwork is not holding equally everywhere. Only a handful of states have passed legislation to create sustainable funding through telecommunication fees, similar to how911 is funded. Research has found that sufficient funding was earmarked in fewer than half of all states to meet the projected increase in call demand. So when funding is insufficient, staffing suffers, which means wait times get higher, calls get rerouted out of state, and counselors burn out. The federal funding picture has also been complicated by broader policy changes. Proposed Medicaid cuts threaten the downstream care that 988 is supposed to connect people to. So if Medicaid is cut, if programs are cut, then there's even less of that. Where do people go after they call 988? And the recent discontinuation of the specialized LGBTQ line is a concrete example of how policy decisions can remove supports from the populations that need them most. That line, which was accessible by pressing 3, was discontinued in July 2025 under the current administration. According to KFF data, LGBTQ youth accounted for nearly 20% of all texts to 988, and the line's contacts had actually peaked the month before it was cut. That is a significant loss for a population already at an elevated risk. There are other groups, such as The Trevor Project that seek to support LGBTQ youth and provide resources there. So what still needs to happen? I want to talk about where the path forward is, because some of these challenges are real. The crisis care framework that SAMHSA has articulated and that states are slowly building toward describes three things that every person in crisis should be able to access. Number one is someone to contact, someone to respond in person when needed. That's number two. And then a safe place to go is number three. Clearly, 988 handles the first one. The second depends more on a mobile crisis team of some sort. I think most of us have identified and law enforcement tends to agree they are not typically the best frontline person to respond when needed. They are not always trained in the same way that a mental health professional would be. And while mobile crisis teams have grown significantly, with more than 2,100 teams now operating nationally, they are still not in every community. And the third piece depends on crisis stabilization programs, which have also expanded but remain unevenly distributed. Building out all three legs of that framework consistently, equitably, and with reliable funding is the work ahead. Data standardization is also essential. Right now, only a fraction of states collect and publish robust data on who is calling, what happens during the call, and very importantly, what happens afterward. Without that data, it's difficult to identify what's working and for whom it's working and where the investment needs to go next. Lastly, I want to say that clinicians, practice owners, are a critical part of what comes after the 988 call. When someone reaches out in crisis and then needs ongoing care, they need to be able to find it. The fragmentation of our system, the insurance barriers, the wait lists and the workforce shortages all become visible in the moments after a crisis contact. 988 does not operate in isolation. It's just one piece of a system that all of us are building in an industry where we are all working to try to support the best care possible. So I hope that you have found this conversation helpful about 988 and the process there, and maybe even some thought about how your work can integrate with this. How does 988 support you in the work that you do? How do you support 988? How do those need to work together more and more? I think our communities need to be thinking more in terms of how all the collaboration is happening. So thank you for listening. Today we will continue to talk about crisis teams as well as all of the different changes in the mental health industry. Everything we talked about in the articles will be in the show notes, so feel free to check those out. And stay tuned for next week where we continue to talk about more issues shaping the future of mental health care. Bye for now.