988 Lifeline focuses on increasing awareness in second year

Despite low public awareness, the 988 Suicide & Crisis Lifeline answered nearly five million texts, chats, and calls in its first year.

Launched in July 2022, the 988 Lifeline answered two million more contacts in a 12-month period than the 10-digit National Suicide Prevention Lifeline it replaced, according to Vibrant Emotional Health, which manages the 988 program.

The most dramatic increase nationally was texting, according to Vibrant. Text volume increased 1,135 percent (from 87,000 to 673,500 texts) compared to the 12 months prior.

Forty-six percent more phone calls were answered, while 141 percent more chats were answered. The average speed to answer all contacts decreased from two minutes, 39 seconds to 41 seconds.

Rhode Island and Connecticut are two of only 14 states with average 988 call answer rates of 90 percent or higher, according to KFF analysis of 988 Suicide & Crisis Lifeline data from July 2022 through May 2023.

Massachusetts, New Hampshire, and Maine each average 80 percent to 89 percent, while Vermont averages 70 percent to 79 percent.

In May, for example, Rhode Island received 1,439 988 calls, an average of 46 per day. This rate is double the number the state received at the same time last year via its 414 BH Link behavioral health crisis hotline. The BH Link number is still operational.

“If we have a high 988 call volume, this enables us to have reliable back-up,” said Cliff Cabral, DHA, LMHC, CEO of Horizon Healthcare Partners, a consortium of seven behavioral health agencies that help manage the 988 Lifeline in Rhode Island.

Reaching more people

Increased awareness of 988 could boost these numbers even further. A recent Pew Charitable Trust survey found that only 13 percent of U.S. adults have heard about the 988 Hotline and understand its purpose of connecting people in crisis with a trained mental health or substance abuse counselor.

Of that 13 percent, about seven in 10 said they would be somewhat or highly likely to use it. Approximately two in five were concerned that if they called, there could be negative consequences, such as charges for hospital services they could not afford or law enforcement being called.

The Pew research showed that awareness was greater with people who identity as white, have a higher income, or have completed a higher education level. Awareness was also higher among individuals who had been diagnosed with or thought they had a mental health issue, or who identified as LGBT+.

While the provider and first responder communities in Rhode Island are aware of 988, Cabral acknowledged that visibility in the general public could be higher. “We haven’t done specific research statewide, but we suspect name recognition is low.”

To help remedy that, messaging about 988 has been included in marketing for other related programs and fundraisers in Rhode Island, such as the recent Check the Stigma Hockey Classic.

Nationally, Vibrant will launch a marketing campaign this fall to help increase awareness and outreach for the 988 Lifeline nationally, said Kelly Clarke, vice president of 988 Suicide & Crisis Lifeline at Vibrant Emotional Health.

In other efforts to increase the service’s reach, it is also developing a direct 988 Lifeline VideoPhone option for Deaf or hard-of-hearing American Sign Language users.

Staffing challenges

While staffing of the 988 Lifeline call center has sometimes been a challenge, Cabral said this is no surprise, noting that staffing has always been an ongoing concern in behavioral health.

“Throughout my entire career, every program I’ve ever been a part of operates with a 25 percent vacancy rate,” Cabral said, noting that workarounds such as deferring calls to the BH Link number have helped the state maintain its high answer rate.

Lines dedicated to specific groups and needs are also helping calls get answered. Of the five million contacts nationwide in the past year, more than 700,000 were routed to the Veterans Crisis Line (VCL), noted Clarke.

Veterans and their families can reach the VCL by dialing 988 and pressing option 1. A dedicated 988 line for LGBTQI+ youth and young adults under age 25 with chat and text options launched this summer.

Cabral noted that Rhode Island is also continuing to build out its capacity for text and chat on 988 as well. Staffing comes into play to make that happen, he said, noting that counselors can’t simultaneously focus on voice and text interactions. “There is also a lot that goes into tracking those text conversations from an IT point of view, but we see contacting us [by text or chat] as the future trend, especially for younger people.”