State of Mind

Three Things to Know When You Call 988

Hands hold a smartphone with the numbers 988 on it.
Photo illustration by Slate. Photo by Getty Images Plus.

Welcome to State of Mind, a new section from Slate and Arizona State University dedicated to exploring mental health. Follow us on Twitter.

By now, you may have heard of 988, the national mental health crisis hotline that launched in July.  It’s a repackaged version of 1-800-273-TALK, popularly known as the “suicide hotline” or the Suicide Prevention Lifeline. The short, easy to remember number is intended to offer an alternative to 911 in crises related to suicidal ideation, substance use, or other mental health emergencies. But if you are wary of 988, or are unsure how to use it, you are not alone.

Advertisement

In its current form, 911 is not optimized for mental health crises. If your loved one is having a manic episode or if you are struggling with substance use, armed police officers knocking on your door is usually not the most helpful response. But until recently, most Americans were left with no other option than to take this risk. 988 offers an alternative path to give more people the care they need. Callers interact with counselors who—unlike most 911 first responders—are specifically trained to handle mental health emergencies.

Advertisement
Advertisement
Advertisement

988 is the result of a series of policy successes, including the fee structure Mental Health Colorado — which I lead—helped establish to help fund this new crisis response system in our state. But policy is not enough. We need buy-in from the public. Americans must understand how to use the hotline. And crucially, they need to actually want to call. This will require rebuilding trust. More than one-third of American adults do not trust the police to respond to mental health emergencies. Furthermore, one study found that 22 percent of deaths due to lethal force by law enforcement occurred as a result of a mental health call.

Advertisement
Advertisement

That same study found that Black people were disproportionately killed by law enforcement officers in these instances, making it unsurprising that this mistrust exists more intensely in historically marginalized communities.  If people are apprehensive of 988 and choose not to call for help, then the hotline will quite simply not do its job.

Understanding how 988 works might help people grow more comfortable with the idea of picking up the phone. Here are three essential facts to know before calling 988.

1. What should I say when I call?

When calling 988 for assistance in a mental health crisis—whether for yourself or others—you should be specific. The more clear and concise you can be when telling the operator what you need, the better. This is hard if you or a loved one is experiencing a mental health crisis. That’s why it’s important to have this sentence handy before you end up in an emergency. Besides describing the situation you are in, I recommend saying “I am calling for clinical support.” This lets the operator know that you are looking for healing health care interventions      and that no one’s life is at risk. Luckily, the vast majority of calls to 988 will not require a dispatch of emergency personnel—police or otherwise. But, if you do not want a police presence, you should still be as specific as possible. After telling the person on the other end of your call that you are looking for clinical support, say “I do not want a police response. I am looking for health care assistance.” This clarity will reduce the odds of unwanted police officers showing up at your door. The last thing we want is for people to be harmed because they thought the consequences of reaching out for help would only put them or their loved ones in more danger.

Advertisement
Advertisement
Advertisement
Advertisement

2. Who will answer the phone?

Calls to 988 are routed to your local Lifeline network crisis center. based on your area codes. The service does not use geolocation—meaning they cannot trace your call. Clearly this is an imperfect system, as many of us use cell phones with area codes that don’t correspond to our current locations. However, for most people, that should be fine; it is exceedingly rare that 988 calls require a response beyond a phone conversation. The FCC is working with state and local governments to set up a system that refers calls based on your physical location. I encourage you to let your elected officials know that this—and other 988 funding issues—is a priority.

Advertisement
Advertisement

3. What they can offer me?

A trained crisis counselor will listen to your call and talk you through what you are experiencing and what your options are going forward. For most callers, this conversation itself will be a sufficient intervention, but counselors may also follow up with callers to check on their progress or provide recommendations for in-person care in your area. The specific details will vary widely based on the funding and resources available in each location and each caller’s individual needs. A counselor may share links to online resources or help a caller make a plan to meet with a telehealth or in-person care provider to continue to address their needs.

Advertisement
Advertisement

Unlike 911, this hotline is not geared toward  dispatching emergency personnel. Prior to the switch to 988, only 2 percent of Lifeline calls required any in-person response. 988 operators should only activate the 911 system if there is an imminent risk to someone’s life, which often means a suicide attempt is underway.

Advertisement

In those very rare cases, the first responders who will come to your aid will vary based on your location. Ideally, we will get to a place where every city will have dedicated mental health responders to handle these situations like the CAHOOTS program in Eugene and STAR in Denver—but for that, lawmakers will have to take action.

988 is an important step in the right direction, but it is not the full journey. We must continue to invest in responses like in-person mental health first response teams and fund accessible, preventative care that meets people’s basic needs and keeps us from reaching those crisis situations in the first place. No one wants to be in the position of calling 988, but by being ready, you could help save a life.

State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.

Advertisement