What is 988? The suicide prevention lifeline

By Katie Dineen

Too often a lack of resources and social stigma leaves people who need mental health support without help. As a consequence, we have seen an “ineffective and deadly” response to people experiencing mental health crises.

The 988 crisis line is an opportunity to reimagine mental health and substance use disorder crisis response to give people the help they need. Through one easy-to-remember phone number, 988 will ensure that anyone experiencing a mental health crisis receives the care they deserve.

How did we get here?

In 2020, Congress unanimously passed the National Suicide Hotline Designation Act establishing a three-digit number (988) for a new mental health crisis response system. 988 will route callers to the National Suicide Prevention Lifeline to expand access to crisis counseling and life-saving services. The goals of the National Suicide Hotline Designation Act are to:

• Reduce health care spending with more cost-effective early intervention
• Reduce use of law enforcement, public health, and other safety resources
• Meet the growing need for crisis intervention at scale
• Help end stigma toward those seeking or accessing mental healthcare

The new 988 crisis line launches nationwide on July 16, 2022.

Why is 988 important?

California is facing a mental health crisis. One in 6 Californians now live with a mental illness and suicides have been steadily climbing, increasing by 35% nationally over the last two decades. This tragic trend has only been exacerbated by COVID-19.

For decades, California has failed to provide necessary mental health crisis services amidst this growing mental health crisis. As a result, the police and the criminal justice system as a whole often serve as the state’s default mental health providers. Currently, 10% of law enforcement agencies’ budgets — and 20% of staff time — are spent responding to individuals with mental illness.

As a direct consequence of our overreliance on law enforcement responses to a public health crisis, approximately 25% of all individuals killed in police-involved shootings since 2015 had a known mental illness, with black men dying disproportionately.

In 2019, Miles Hall, a 23-year-old black man living in Walnut Creek, was in the midst of a schizophrenic mental health crisis when his family called 911 for help. Despite being familiar with Miles’ condition, the officers resorted to lethal force within a minute of their arrival.

In 2020, Antioch, California resident and Navy veteran Angelo Quinto died while being restrained by police after his family called 911 for help. He lived with anxiety and depression and his family hoped to de-escalate Angelo’s then-erratic behavior.

What’s happening in California?

While the National Suicide Hotline Designation Act of 2020 established the new three-digit number, it is up to states to build and fund the crisis response system connected to 988. In California, the Steinberg Institute is leading this effort through AB 988, the Miles Hall Lifeline and Suicide Prevention Act. Authored by Assemblymember Rebecca Bauer-Kahan (D-San Ramon), this bill would ensure sustained funding and a framework for 988 implementation.

If AB 988 passes, the state will work to build out a 988 crisis system that provides immediate crisis and stabilization support, both over the phone and in-person if needed. It’s anticipated over 90% of calls to 988 will be resolved by trained crisis counselors over the phone. In cases where more intensive support is needed, callers would be connected with mobile crisis teams as an alternative to law enforcement. These teams, composed of mental health professionals and peers, de-escalate situations and connect those in crisis to services. Instead of jails and emergency rooms, individuals will be connected to crisis receiving and stabilization services. These “trauma-informed programs” provide short-term and follow-up care.

The national picture

Federal, state and local action is needed to ensure response services are available in every community. Though a handful of states have passed 988 legislation to “strengthen crisis response infrastructure” along with funding, few have established procedures to coordinate 988 calls with local services.

States must create implementation plans, set up sustainable funding for 988, and educate communities about the new service. The 988 system needs state leadership to be fully realized as a transformational crisis response opportunity.

California State of Mind Essentials is published by the Steinberg Institute, an independent nonprofit organization working to focus public attention on mental health issues in California and to advance sound public policies that can help people in our state get the assistance and support they need.