Dr. Matthew Wintersteen, a psychologist and Pennsylvania leader in establishing this national lifeline, offers everything you need to know about the new three-digit number.
Content Warning: Information presented in this article may be triggering to some people. If you are experiencing suicidal thoughts, contact the Suicide and Crisis Lifeline at 988 (call or text), for support and assistance from a trained counselor. If you or a loved one require immediate medical attention, call 911.
The Federal Communications Commission formally designated 9-8-8 as a nationwide three-digit number for mental health crisis and suicide prevention services as of July 16, 2022.
“A three-digit lifeline number positions behavioral health crises as just as important as physical health crises for which you would call 911,” says Matthew Wintersteen, PhD, psychologist and associate professor in the department of psychiatry and human behavior.
Here is what you need to know about the new number and the effort to streamline access to urgent mental health care.
What was the motivation behind the new 988 national lifeline number?
To clarify, 988 is not a new service. It’s a new phone number for an existing service. In fact, people can still call the 1-800-273-8255 number to get to the exact same crisis counselors who are going to respond to them. There is no difference in the service. It is just being promoted more broadly and is a much easier number to remember—in the same way we don’t think twice about remembering to call 911 when there’s a fire or medical emergency.
The goal of 988 was to establish a faster, more recognizable route to get to what used to be called the National Suicide Prevention Lifelife. It’s now called the Suicide and Crisis Lifeline. You can call or text that number or go to 988lifeline.org to access the chat service.
What are the main differences between calling 988 and calling 911?
The number 988 was developed to serve as the behavioral health equivalent to 911. You call 911 for emergencies that require law enforcement, EMS, fire rescue, etc. The number 988 is the equivalent type of service for the behavioral health field. The goal is that people who are in a behavioral health crisis have an easier time remembering the right number to call if they are alone and need support, or if they are concerned about their own well-being and need a lifeline to help guide them in a moment of distress.
Another important difference is if you call 911 in a behavioral health emergency, the likelihood of law enforcement showing up at your house is incredibly high—nearly 100%. They’re going to dispatch somebody to your house because the purpose of 911 is not to counsel, listen or be supportive towards you. Their job is really to dispatch the appropriate level of emergency service to you. Alternatively, if someone calls 988, their primary responsibility is to listen, advise, talk, counsel and assist them through whatever crisis they’re having at the moment.
The average 988 call lasts about 20 minutes—many of them are considerably shorter, but there are also quite a few that might take much longer than that. The purpose is to assist that person so that they’re no longer in crisis and do not require any sort of dispatch to their home to provide in-person assistance. We know that through data, the National Suicide Prevention Lifeline—which is, again, the same service 988 now offers—that about 80% of the time, when somebody calls, their crisis is resolved over the phone, such that no dispatch is needed to their home, whether it be a mobile crisis unit or EMS or law enforcement to assist. This is especially important right now in Philadelphia, as many people would prefer that law enforcement not show up for behavioral health crises. It is also consistent with the state’s overall goal to have the appropriate response for the emergency at hand.
Whether or not law enforcement is dispatched comes down to a safety issue. It is never the priority nor the first effort for a 988 counselor to engage local law enforcement for assistance. However, if someone is expressing suicidal thoughts and is in possession of a firearm, it may be necessary for law enforcement to co-respond with a mobile crisis team to ensure that the situation is safe before putting the mobile crisis team in harm’s way.
Does calling 988 reveal your exact location?
The 988 support line does not have geolocation. Geolocation is the tool that 911 call centers utilize to ping off cell phone towers to get a general sense as to where somebody is calling from. Presently, 988 call centers do not have that technology. If you call 988 and need someone dispatched to your home, like a mobile crisis team or EMS, for example, you’re going to need to reveal your location for them to send help to you.
It’s important to note that when you call 988, you get routed to the nearest call center associated with the phone number from which you are calling. This is important, particularly in large cities like Philadelphia, where there are a lot of people who move in and out of the city. If you are in Philadelphia but are using a cell phone that you did not get from the Philadelphia area or even within Pennsylvania, your call is probably going to be answered elsewhere and possibly out of state if that is where your cell phone number originated.
Do you see this as an obstacle to getting people care quickly?
There are certainly pros and cons to geolocation. The advantage of geolocation is that as people migrate around the country for school or jobs or to live, you’re more likely to get the call center that is most closely associated with where you happen to be at the time of your crisis.
The disadvantage of geolocation really comes down to the question that was asked earlier – which is once geolocation exists, the only way to do that is to use technology that pings cell phone towers, which gives the call centers a general idea as to where you are located. Now, that’s actually a very good thing when it comes to rescue help, because sometimes people are in a crisis, and they would like someone to come to them, but either they don’t know exactly where they are, or they’re hesitant to say exactly where they are. And so, geolocation will allow emergency services to get to that person.
The flip side of that is that there are plenty of people who call this service because it’s anonymous and they don’t necessarily want to tell people who they are. They want help, but they don’t want to discuss who they are or where they are. They don’t want anybody coming to them. In fact, in most circumstances, they may not need anybody to come to them.
Can you describe the sort of situation that someone should call 988 for themselves or a loved one?
It’s important to recognize that 988 is not designed to be what they call a warm line. Warm lines are numbers that you can call when you’re having a bad day and just need someone to talk to. The 988 line is designed to support someone in crisis.
We know that oftentimes when people become suicidal or contemplate engaging in suicidal behavior, they may be alone. It isn’t the case that they have somebody near them, to whom they could reach out and get immediate support from a peer. Data from the National Suicide Prevention Lifeline shows there are plenty of people who call when there is nowhere else to turn or anyone else to talk to. In moments where somebody is suicidal, they’re often alone, they’re separating themselves from other people. They’re unburdening others, in their mind, from whatever it is that they believe that they’re putting on them. This is why an easy-to-recall number is so important. The number for support needs to be easy to remember when you’re overwhelmed with feelings like these.
[Editor’s Note: Learn more about how to recognize signs of hopelessness from Dr. Wintersteen here.]
What happens when you call on behalf of someone you are concerned about? Can you remain anonymous?
It depends on what you want to happen and the level of support that person needs. If you call for someone and the call center counselor is equally concerned, they’ll often want to speak with that individual, or text or chat if that makes them more comfortable.
If you believe the person is at imminent risk and is either in the process of self-harming or will harm themselves, you should call 911. For example, if someone has posted something on social media that suggests they are about to make a suicide attempt, and you don’t know where they are and they’re not responding to calls or texts, those are times you want to call 911. The reason is that you need someone to immediately show up for this person and EMS will likely also be sent out in case they are injured and need immediate medical attention or need to be taken to a hospital.
It can be confusing for people to know which number to call—988 or 911. My best recommendation is that if you feel someone is at imminent risk of harming themselves, call 911. They have a better chance of finding the person quickly. If you are concerned about somebody who may be suicidal and know they are experiencing a behavioral health crisis, you can certainly call 988 to figure out how to best support that person.
Is there any misinformation about 988 out there since the lifeline launched last month?
One thing I’ve seen on social media lately is that calling 988 will result in the police being dispatched to your house.
If you call 988 and you are at imminent risk and you live in an area where there is not a mobile crisis team, and this is true in some places like rural Pennsylvania, oftentimes police are then deployed. If you need somebody to come to you because you are at imminent risk for injury or death, and there is no other option, then law enforcement can be deployed. It is not by any stretch the first option. In fact, they’ve changed the protocol at 988 such that if law enforcement needs to be dispatched, the crisis counselor responding to the call has to go through a supervisor before they can actually do that.
One of the greatest priorities of 988 of the federal government is to divert behavioral health calls away from law enforcement. Not because they are incapable of handling it, but because there are more appropriate services and law enforcement is better suited to respond to other needs in the community.
What motivated you personally to work in the field of suicide prevention?
Many people who are in the suicide prevention field got into the field because they know someone who died by suicide and so it became sort of a passion to find ways to alleviate mental distress and the things that lead to suicidal thoughts and behaviors. Interestingly, that wasn’t my path. I started doing work with depressed adolescents and doing family therapy with them. Through that, I started seeing lots of kids who were suicidal and began doing research on how to best support them using family therapy as an intervention. Consequently, I was part of a grant from the CDC to do a family-based intervention for suicidal youth. I quickly became an expert in suicide prevention interventions because the pediatricians needed support when they were trying to identify kids who could be at risk. At the time, this was a niche field of research no one else was exploring. It was an opportunity to provide both clinical and educational support in areas that others weren’t focused on at the time.
Then there’s the fact I work in a helping profession field, and so of course I was motivated to help other people. There’s a misconception that when someone gets to the point of feeling suicidal, there’s little hope that they can get better. I know that’s not the case. When you work with someone who is truly struggling with suicidal thoughts and behaviors, and then you see them get better, it’s rewarding. You know that you’ve done good work.
[Main photo credit: iStock.com/Delmaine Donson]