The 988 suicide and crisis lifeline began in July of 2022, looking to battle the ever-growing suicide rates head-on with ease and efficiency of a “911” type system.

Following a year of services, mental health officials discussed the successes, and shortcomings, of the national system.

The Association of Health Care Journalists held a webinar on Thursday to discuss 988’s first-year statistics and the questions that still remain going forward. 

“As a nation, we are in a vast public health crisis when it comes to mental health,” said Vincent Atchity, President and CEO of Mental Health Colorado. “There’s a pediatric state of emergency when it comes to mental health.”

National suicide rates rose another 2.6% in 2022, following a 5% increase in 2021, according to the U.S. Centers for Disease Control and Prevention. An estimated 49,449 Americans lost their lives to suicide in 2022. 

The 988 lifeline looks to bring mental health issues to the forefront, with easy access to immediate and long-term care. The national number was mandated by the National Suicide Hotline Designation Act of 2020, and requires each state to have a call center that puts callers and texters in contact with a live counselor. It looks to carve out an identity of access and response akin to 911 emergency services.

Since launching last year, 988 has received more than 5 million contacts, ranging from calls to texts and chats. And national answer rates increased to 93% in May 2023, up from 70% the same month the year before, according to the KFF health policy research group.

Though the nationwide effort has helped reach millions of those in need, the building blocks are still being placed.

“Only around 13% of people know that 988 exists,” Heather Saunders, a postdoctoral fellow at KFF, said.

Saunders points to an increase in data that could help bolster understanding and implementation. She asks for statistics like why, exactly, people are calling, what their experience with the call representative is, and whether they are comfortable while speaking on the hotline. All of which may improve services and outreach. 

“I think that we tend to forget – because we’re so familiar with 911 and it’s convenience – is that while 911 was conceived in the late 60s, we didn’t get to the point where over 90% of the U.S. had availability to dial 911 until the year 2000,” Atchity said. “And so I think that it’s important for all of us to just remember that it is going to take some time for 988 to become the thing that we need it to be.”

It’s creating that strong infrastructure and awareness, like 911 dispatch has done over 60 years, that needs to be done to improve results. 

Funding and staffing have proven to be an issue for a plethora of state crisis centers. Though federal budgets support 988 nationally, states are responsible for the long-term funding of their own call centers.

While Colorado has supported its crisis center through 2021 legislation that allows for funding through telecom fees, other states rely on volunteering and private donations.

With the extreme nature of crisis hotline jobs and the need for competitive salaries, hiring can become tough. Even Colorado, a state with hotline funding, faces workforce challenges, Atchity said. 

There’s also the fear that “prevalent response” to mental health crises will still be police officers, not mental health professionals. 

“There are communities in context in which I would be as anxious about resorting to 988 as I might be about resorting to 911 because the prevalent response may still be a law enforcement response or response that’s discriminatory or traumatizing,” Atchity said.

Atchity added that if you were to call 988 for a crisis in rural Colorado, for example, the response team may be an untrained sheriff because they are the only people on call.

“The level of cultural competency and reliable compassion and person-centric response is not as high a level as we, who dream up such things as a robust continuity of care, might imagine,” he said. 

Through more data reporting, the raising of awareness and the creation of more infrastructure, 988 will continue to address the mental health crisis moving forward, officials said.

It starts with conversations like this.