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988: A New Resource Every Social Worker Should Be Talking About
By Jada D. Bruce and Heidi Breaux, DSW, LCSW-BACS, LCSW-R

According to the US Department of Health and Human Services, suicide is the 12th-leading cause of death in America.1 Ninety percent of people who complete suicide have a mental health disorder; however, many go undiagnosed or treated due to lack of access to care or stigma.2 One-third of people who die by suicide have trouble accessing medical or psychological care due to financial issues, waiting times, and reduced inpatient and outpatient services.

An important new resource aiming to help reduce this statistic is the 988 hotline. Since 2005, more than 23 million people have called the National Suicide Prevention Lifeline at 1-800-273-8255. In 2021, amidst the COVID-19 pandemic, the hotline had its busiest year with more than 2.5 million calls.3,4

Under the Biden-Harris administration, Congress passed S. 2661: the National Suicide Hotline Designation Act of 2020. On July 16, the hotline number changed from the former 1-800 number to three simple and easy to remember digits: 988. This resource is available for voice calls or texts 24 hours a day, seven days a week. Some of the goals of changing the number include increasing access by offering an easy-to-remember, three-digit number that is purposefully similar to 911, dispatching calls to a local crisis team, reducing police and emergency medical service involvement, providing follow-up care after initial calls, avoiding emergency department visits when not needed, and reducing the stigma of and barriers to accessing mental health services.3,4

What to Expect When Calling 988
Since response time is an important factor in mental health emergencies, the hotline aims to answer all calls within 20 seconds.5 When callers dial in, they will hear a short greeting. Depending upon their selection, the caller will be dispatched to the appropriate responder in the caller’s local area. Crisis counselors who answer the line are all trained to counsel in suicide, substance abuse, and mental health.

During the call, counselors will listen, deescalate, and refer to any resources that could be helpful. Each call center is staffed locally with a trained counselor. If the local call center is unable to answer, the call will be rerouted to the next nearest call center in the database.3,4

The hotline aims to handle mental health crisis independently whenever possible and only include emergency medical service or law enforcement when necessary. Research in 2022 indicated that only 2% of calls to the hotline needed additional emergency or police intervention.5

A New Resource
The federal budget for the hotline is $423 million for 2022, and $700 million for 2023. The hotline also receives additional funding from private grants and the states. Currently, funding will go toward setting up infrastructure to receive calls and texts, and employment costs for counselors.3,4 Each state will be responsible for the call centers within its jurisdiction. While some states may choose to employ counselors, other states will have volunteers on the line.5 To appropriately fund the 988 hotline and treat mental health emergencies the same as medical emergencies, advocates believe the initiative should receive funding like 911, which costs $4.9 billion annually to operate. From the inception of 911, it took 20 years for the system and call center to become fully functional.

Based on this timeline, expecting 988 to operate smoothly at the start may be an overarching goal.6 In February, The Trevor Project polled 2,210 people about suicide prevention and the new 988 lifeline. The survey reported that 7 out of 10 adults trust and prefer social workers, psychologists, and trained mental health professionals to respond to crisis calls instead of police dispatchers. Women over 45 and men over 75 have the highest incidence of suicide; the survey found that Gen Z, Millennials, and their parents are the most likely to know about 988.7

The Future of Suicide Prevention
Several risk factors contribute to suicide, which is a preventable death. The top risk factor is a previous attempt. Other contributing factors include mental health disorders such as anxiety and depression, and impulsivity as a reaction to uncontrollable circumstances when dealing with stress related to many different situations, such as loss of a job, relationship breakups, grieving, and illness.8

Indigenous Americans have the highest rates of suicide in America, followed by white, non-Hispanic males, and biracial groups. Age is also a risk factor, with women aged 45 to 64 and men over 75 years old having the highest rate.9,10 Marginalized groups such as members of the LGBTQIA+ community, people with limited access to medical care, the elderly, members of the military, and veterans are also at higher risk.9,10

Protective factors against suicide include having a strong social network, limited means to tools used for lethal harm (for example, gun control, poison control, and medication control), and access to available quality mental and physical health care resources.1 While 988 may not fully solve all of these disparities, it is a step in a positive direction in that it should increase access to care and improve response times.

Suicide is not a diagnosis; it is the result of a fatal act. Prevention is imperative, and 988 will be a key component in the response. For people who do not have access to mental health services, the easy-to-recall 988 hotline helps close this gap.1 The hope is that 988 will “empower individuals, advance professional best practices, and build awareness.”3,4 These goals align with the NASW’s Code of Ethics in that a free hotline and trained and compassionate call center workers will help ensure the dignity of individuals, equitable distribution of resources, and professional competency.11

For 988 to be successful, word of its arrival must be spread and individuals must feel comfortable accessing it. Social workers should advocate for streamlined, frequent screenings for suicidal ideation, lobby for more access to affordable care and mental health services, and assist in national prevention initiatives.12 All social workers must raise awareness of 988 and should consider advocating for the continued expansion of these services.

— Jada D. Bruce is an MSW student at Louisiana State University School of Social Work.

— Heidi Breaux, DSW, LCSW-BACS, LCSW-R, is an assistant professor of professional practice at Louisiana State University School of Social Work.

References
1. Suicide. National Institute of Mental Health website. https://www.nimh.nih.gov/health/statistics/suicide. Updated June 2022.

2. Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE, eds. Reducing Suicide: A National Imperative. National Academies Press; 2002.

3. Substance Abuse and Mental Health Services Administration. 988 appropriations report. https://www.samhsa.gov/sites/default/files/988-appropriations-report.pdf. Published December 2021.

4. 988 frequently asked questions. Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/find-help/988/faqs. Updated September 2, 2022.

5. Kuntz L. New 988 suicide hotline hope or hype? Psychiatric Times. 2022;39(7):1-11. https://www.psychiatrictimes.com/view/new-988-suicide-hotline-hope-or-hype

6. Ross R. Closing the 911 funding gap: Increasing revenues for 911 emergency dispatch centers. Certified Public Manager Applied Research. 2022;1(1). https://scholarworks.sfasu.edu/cpmar/vol1/iss1/4

7. The Trevor Project. U.S. adults’ knowledge on suicide prevention and 988. https://www.thetrevorproject.org/wp-content/uploads/2022/04/988-poll-report.pdf. Published April 2022.

8. Suicide. World Health Organization website. https://www.who.int/news-room/fact-sheets/detail/suicide. Updated June 17, 2021.

9. Risk and protective factors. Centers for Disease Control and Prevention website. https://www.cdc.gov/suicide/factors/index.html Updated August 5, 2022.

10. Suicide mortality by state. Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm. Updated March 1, 2022.

11. Code of ethics. National Association of Social Workers website. https://www.socialworkers.org/About/Ethics/Code-of-Ethics

12. Maple M, Pearce T, Sanford RL, Cerel J. The role of social work in suicide prevention, intervention, and postvention: a scoping review. Australian Social Work. 2016;70(3):289-301.