Three Life-Saving Digits: Insights from the US 988 Suicide and Crisis Lifeline

by Dr Banu Cankaya Sahin

In moments of crisis, remembering a phone number that connects to immediate help can make all the difference. 

In July 2022, the United States (US) launched the three-digit 988 Suicide and Crisis Lifeline, replacing the 1-800 National Suicide Prevention Lifeline (1-800-273-TALK) that had been operating since 2005.

Similar to 911 in the US or 999 in the United Kingdom (UK), a three-digit number is easier to remember and may help people to reach support faster. But has this change actually led to an increase in the use of crisis helpline services, and what might this mean for suicide prevention efforts?

This blog explores early evidence following the launch of the 988 Lifeline and what it tells us about the role of crisis helplines in suicide prevention.

What Are Crisis Helplines?

Crisis helplines are a key part of suicide prevention strategies worldwide. They provide immediate, accessible support to individuals experiencing emotional distress, suicide-related distress and other mental health crises.  

Most crisis helplines offer phone, text, and online chat options, allowing individuals to use the form of communication they prefer. The 988 Lifeline operates 24 hours a day, seven days a week, offering phone, chat, and text services across the US. Similarly, in the UK, there are crisis support services such as the National Suicide Prevention Helpline, Samaritans and Shout Crisis Text Line and Breathing Space.

While services vary across countries, most helplines follow a similar model focused on reflective and compassionate listening, risk assessment, and keeping people safe.

Key Features of the 988 Lifeline

The 988 Lifeline aims to help individuals stay safe and de-escalate crises related to suicidal behaviour, substance use, or other mental health issues.The transition to 988 was accompanied by updated policies, with support following a structured approach that includes the mandatory staff training, standardised risk assessment, and active engagement to build connection and discuss risk, and collaborative safety planning. There is an emphasis on least invasive interventions, meaning local emergency services like 911 are only contacted if the caller can’t ensure their own safety and they are at immediate risk.

Early Findings: Awareness and Use of the 988 Lifeline

Simplifying the number appears to have raised awareness and increased use:

• Public awareness rose from 22% pre-launch to 74% within the first three years.
• The 988 Lifeline has received over 16 million contacts within 2.5-3 years of launch, compared with pre-launch levels of approximately 3 million contacts per year.
• Estimated annual usage among adults nearly doubled, from 0.8% to 1.6% in 2.5 years.

However, understanding of what the service actually provides remained relatively low, albeit rising from 4% to only 28%.  Many individuals recognised the number but were unsure when and why to call the number.

Awareness and use of the 988 Lifeline has not spread equally across the population. Initial data suggests that younger age groups (i.e., 18-29 versus 60 and above) were more likely to use the services. Individuals who were aware of the 988 Lifeline were more likely to have Bachelor’s or higher levels of education, higher incomes, and to be White, non-Hispanic.

These findings highlight a continuing challenge in suicide prevention; simplifying the number for crisis calls alone does not automatically overcome issues related to implementation and gaps in outreach. Individuals still face barriers when seeking help, including low trust in the healthcare system and stigma around mental health and suicide.

Challenges Following the Increasing Demand

While increased help-seeking is encouraging, the rapid growth in demand must be met with equally rapid improvements in crisis care. In just 2.5 years, contacts to 988 doubled, yet funding and service capacity for follow-up and emergency care haven’t increased equally across all US states. Remarkably, evidence suggests a slight decline in the capacity of some community crisis services while only peer support services showed a general modest increase.

These findings point to persistent challenges in securing adequate and sustained advancements in well-integrated broader crisis response systems. Without adequate follow-up care, crisis helplines lack a clear path forward.

Access Alone May Not be Enough

Research has evidenced the short-term efficacy of helplines in reducing hopelessness, entrapment, suicidal intent, and suicidal ideation but evidence on their long-term effectiveness remains limited. Several factors are important for crisis helplines to reach their full potential in suicide prevention:

• Equity in access and use: Targeted programmes are needed to reach underserved communities and to address barriers such as mental health stigma, awareness of mental health needs, and confidentiality concerns.
• Funding and capacity:Meeting increased demand requires increasing funding and workforce (helpers, supervisors), training, and integrated follow-up care.
• Integration: Helplines can be more effective when the centralised crisis helplines are well connected to follow-up care and community-based mental health services.
• Public awareness: Individuals need to understand what helplines provide and when to use them.This may be achieved through campaigns and partnerships with schools, workplaces, healthcare and community organisations.
• Service quality and training: Consistent training, supervision, adherence to protocols, and tailoring support to meet community needs remain key for high quality support.

Conclusion: Does the Three-Digit Number “Do the Trick”?

Simplifying access through a three-digit crisis number appears to increase help-seeking, which is an encouraging finding for suicide prevention, but access alone may not be enough.

Firstly, the experience of helplines is not shared equally across populations. Issues related to trust in services, stigma around mental health, and wider structural inequalities still appear to influence who reaches out. Secondly, helplines must be supported by sustainable funding, well-trained and supervised staff, and strong follow-up and community-based services. A crisis line can provide immediate support in a moment of distress, while long-term impact may depend on what care is available afterwards.

In conclusion, the introduction of the more memorable number (988) is a critical step in opening the door to support for people in crisis. And that first step could go a long way if it is well-resourced and well-connected to follow-up care and community support.