In Brief:
If you know someone who is thinking about suicide, help is available at 988, the Suicide and Crisis Lifeline.
Mid-July marks the second anniversary of the launch of the 988 Suicide and Crisis Lifeline as a nationwide resource offering 24/7 support to people in suicidal distress. Since that time, it has fielded 9.5 million calls, texts and chats.
Awareness of the system, which encompasses more than 200 local crisis centers, has grown steadily. But few Americans understand it the way they understand the 911 emergency number.
In a recent poll by the National Alliance on Mental Illness (NAMI), nearly 7 in 10 respondents said they were “aware” of 988, but fewer than 1 in 4 were at least “somewhat familiar” with it. About half didn’t know when a situation would be serious enough to contact the Lifeline.
“As we look to year three, NAMI’s new poll shows that we’re only scratching the surface on getting the word out about this life-saving resource,” said NAMI Chief Executive Officer Daniel H. Gillison Jr. in announcing the poll’s findings.
At the population level, suicide is not among the top 10 causes of death in the U.S. But the picture is very different for young people in America. Suicide is the second-leading cause of death (after unintentional injury) for people ages 10-14 and 25-34, and third (after homicide) for those between 15 and 24.
The rates are even higher among LGBTQ+ youth, who are four times more likely to attempt suicide than their peers. According to nonprofit The Trevor Project, 4 in 10 LGBTQ+ youth seriously considered taking their own lives in the past year.
The Substance Abuse and Mental Health Services Administration (SAMHSA), which supports 988, has created a subnetwork of counselors specifically trained to help these young people. Text and chat services in Spanish were introduced in 2023.
Building Awareness
In May, SAMHSA announced a campaign of multimedia ads to improve awareness of 988 that would run from June to October of 2024. These will be aimed at populations with disproportionate risk, including younger Americans from the LGBTQ+, Black, and indigenous (American Indian and Alaska Native) communities.
The ads will be placed on social media platforms and channels, including video games and podcasts. They will draw on findings from research by the Ad Council to explore attitudes regarding crisis services, effective messaging regarding them and “trusted messengers” for those facing mental health challenges.
Several key recommendations emerged from this work that have broad application in improving understanding of 988. These included emphasizing the “always on” nature of the service — the nonstop availability of people trained to listen and help who understand and respect the private and confidential nature of what is being discussed. Messaging that emphasized that these interactions are non-judgmental resonated strongly.
In addition to their study, the researchers published a toolkit for general communications about the Suicide and Crisis Lifeline and one for communicating with “trusted messengers” of those who may be at risk, such as parents, friends, spouses and caregivers. A 988 Partner Toolkit from SAMSHA includes links to materials that state and local partners can use to market their services. Print resources are available to the public at no cost.
“SAMHSA’s campaign couldn’t come at a better time to reach more people, especially disproportionately impacted communities,” said NAMI’s Gillison.
The Role of States
As another way of marking the anniversary, NAMI released a brief on state-level trends in regard to 988 and crisis response, covering legislation passed in 2023 that addresses the range of mental health crises that might prompt a 988 call.
These include bills to ensure sustainable funding for 988 and appropriations for crisis response teams that could be sent instead of police to assist persons experiencing mental health emergencies. Several states are considering mechanisms for reimbursing behavioral health services, whether through Medicaid or an endorsement process. Others are proposing evaluation of their 988 systems.
Suicide rates have increased slightly in recent years. At around 48,000, suicide fatalities are a fraction of the lives lost to heart disease or cancer, but they occur nearly twice as frequently as homicides.
Researchers at University of Colorado Boulder found correlations between climbing suicide rates after 2007 and the spread of powerful opioid drugs and declining economic conditions in states, social factors not generally considered among the drivers of recent upticks. While they are not a cause of suicidal crises, firearms have an outsized impact on outcomes. Overall, about 7 percent of suicide attempts succeed. When a gun is involved, the rate is 85 percent.
Self-harm is an extreme manifestation of behavioral health crisis that 9 in 10 Americans recognize as a public health threat. A KFF Mental Health in America survey found that half of American families had experienced a “severe” mental health crisis. About half of those contacted by NAMI felt that Congress and state legislatures are not doing enough to address these risks.
Reflecting this sentiment, NAMI found that more than 80 percent of adults support federal and state funding for 988. Even though most said they weren’t very familiar with the Suicide and Crisis Lifeline, 90 percent believed they would get the help they needed if they contacted it. For half, the most important factor was that a counselor would be available immediately.
“People want to know that if they contact 988, they won’t be put on hold or wait for help,” said Hannah Wesolowski, chief advocacy officer for NAMI. “Continued investments in 988 are critical to meet the demand — and answer calls quickly — as awareness grows.”
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