FAQs About 988 Basics
From SAMHSA (Substance Abuse and Mental Health Services Administration)
Beginning July 16, 2022, 988 became the new three-digit dialing code connecting people to the existing National Suicide Prevention Lifeline, where compassionate, accessible care and support is available for anyone experiencing mental health-related distress—whether that is thoughts of suicide, mental health or substance use crisis, or any other kind of emotional distress. People can also dial 988 if they are worried about a loved one who may need crisis support.
The 988 dialing code is available nationwide for call (multiple languages), text or chat (English only).
The Lifeline accepts calls, texts, and chats from anyone who needs support for a suicidal, mental health and/or substance use crisis.
Moving to 988 does not mean the 1-800-273-8255 number goes away. As of July 16, 2022, using either number will get people to the same services. 988 is an easier-to-remember way to access a strengthened and expanded network of crisis call centers.
The Lifeline responds 24/7 to calls, chats or texts from anyone who needs support for suicidal, mental health, and/or substance use crisis, and connects those in need with trained crisis counselors.
When calling 988, callers first hear a greeting message while their call is routed to the local Lifeline network crisis center (based on the caller’s area code). A trained crisis counselor will answer the phone, listen to the caller, understand how their problem is affecting them, provide support, and share resources if needed. If the local crisis center is unable to take the call, the caller will be automatically routed to a national backup crisis center. The Lifeline provides live crisis center phone services in English and Spanish and uses Language Line Solutions to provide translation services in more than 250 additional languages for people who call 988.
Chat (English only) is available through the Lifeline’s website https://suicidepreventionlifeline.org/chat People seeking chat services will be provided a pre-chat survey before connecting with a counselor that identifies the main area of concern. If there is a wait to chat with a crisis counselor, a wait-time message will appear. If demand is high, individuals can access the Lifeline’s “helpful resources” while waiting, or call 988 or 1-800-273-8255. Once connected, a crisis counselor will listen to you, work to understand how your problem is affecting you, provide support, and share resources that may be helpful.
Text (English only) is available through 988. When someone texts to 988, they will be responded to by a group of Lifeline crisis centers that respond to chat and text. This service will expand over the next few years to increase local and state level response. Once connected, a crisis counselor will listen to you, work to understand how your problem is affecting you, provide support, and share resources that may be helpful.
Yes, the Lifeline works. Numerous studies have shown that most Lifeline callers are significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful after speaking to a Lifeline crisis counselor.
988 was established to improve access to crisis services in a way that meets our country’s growing suicide and mental health-related crisis care needs. 988 will provide easier access to the Lifeline network and related crisis resources, which are distinct from the public safety purposes of 911 (where the focus is on dispatching Emergency Medical Services, fire and police as needed).
The 988 and 911 systems will need to be closely coordinated to seamlessly allow referral of callers for appropriate care or response that addresses the unique circumstances present with each crisis encounter. SAMHSA is actively engaged with 911 counterparts at the federal, state, and local levels to plan for smooth coordination between the two services.
Currently, a small percentage of Lifeline calls require activation of the 911 system when there is imminent risk to someone’s life that cannot be reduced during the Lifeline call. In these cases, the crisis counselor shares information with 911 that is crucial to saving the caller’s life.
The primary goal of the Lifeline is to provide support for people in suicidal crisis or mental health-related distress in the moments they most need it and in a manner which is person-centered. The vast majority of those seeking help from the Lifeline do not require any additional interventions at that moment. Currently, fewer than 2% of Lifeline calls require connection to emergency services like 911. While some safety and health issues may warrant a response from law enforcement and/or Emergency Medical Services (namely when a suicide attempt is in progress), the 988 coordinated response is intended to promote stabilization and care in the least restrictive manner.
All Lifeline crisis centers adhere to the Lifeline’s Imminent Risk Policy, which means that crisis center staff work through active engagement to provide support and assistance for people at risk in the least restrictive setting possible. In fact, most contacts with the Lifeline are resolved by the Lifeline itself, by chat or phone, in a manner that does not require additional immediate intervention.
In most states, the 211 system provides health and social service assistance information and referrals. At the same time, 988 crisis counselors will provide support for people in suicidal crisis or mental health-related distress in the very moments they need it most. While generally being different in scope, these systems need to be aligned, and in many cases, local Lifeline centers also respond to 211 contacts. We envision that 988 crisis centers will need to continue to coordinate with 211 and other warmlines. This will help ensure an all-inclusive approach regardless of which number a person may use first.
There are ongoing efforts to improve cultural competency training for Lifeline crisis counselors. In 2021, there were several activities addressing this, including updating pages on the Lifeline website and creating specific tools for crisis counselors, such as Spanish-language clinical guidance resources, Deaf and Hard of Hearing best practices for callers/chat visitors, an LGBTQ+ guidance document, an American Indian/Alaskan Native tip sheet and more.
It’s important to understand that 988 connects people to more than just a “suicide” line, it is a service for anyone who is suicidal or experiencing a mental health- and/or substance use-related crisis. It’s important we don’t call this only a “suicide” lifeline, but instead refer to it as the 988 Suicide & Crisis Lifeline.
988 will be the new easy-to-remember number to reach the existing National Suicide Prevention Lifeline.
Anyone who needs suicide or mental health-related crisis support, or who has a loved one in crisis, can connect with a trained counselor by calling (multiple languages), chatting, or texting (English only) 988 (as long as the caller has telephone, cellular or internet services available to them).
SAMHSA’s longer-term vision is that transition to 988 will spur the growth of a robust crisis care system across our country that links callers to community-based providers who can deliver a full range of crisis care services (like mobile crisis teams or stabilization centers). Currently, these crisis care services do not exist in all areas of the country, and it will take time and sustained support for this crisis care system to evolve.
Anyone who needs suicide or mental health-related crisis support, or who has a loved one in crisis, can connect with a trained counselor by calling, chatting, or texting 988 (as long as the caller has telephone, cellular or internet services available to them).
Yes, the Lifeline responds 24/7 to calls (multiple languages), chats, or texts (English only) from anyone who needs mental health-related or suicide crisis support and connects them with trained crisis counselors. The support and service received from the crisis counselors is provided at no charge to those who use the service; however, standard data rates from telecommunication mobile carriers may apply to those who text to the Lifeline.
The Lifeline currently provides live crisis center calling services in English and Spanish and uses Language Line Solutions to provide translation services in over 250 additional languages. Text and chat are currently available in English only.
The Lifeline currently serves TTY users either through their preferred relay service or by dialing 711 then 1-800-273-8255. Lifeline also offers services through chat and text. Lifeline is in the process of expanding to video phone service to better serve deaf or hard of hearing individuals seeking help through the Lifeline/988.
SAMHSA is working closely with the Lifeline administrator to ensure this critical functionality is enabled as quickly as possible. Right now, people who speak Spanish and other languages should call 988 to reach a crisis counselor who can speak with them in their native language.
The Lifeline is a national network of about 200 local, independent crisis centers equipped to help people in mental health-related distress or experiencing a suicidal crisis via call (multiple languages), text or chat (English only).
988 – Emergency line: National Crisis and Suicide Hotline
911 – Emergency line: Police, Fire, Accidents, Crime
211 – Idaho Care Line: Public Health and Community Services
311 – Non-emergency line for police, fire, and municipal business
411 – Information: Directory assistance
511 – Road and Traffic Conditions
711 – Telecommunications Relay Service for the speech and hearing impaired
811 – Call before you dig: Underground Public Utility Location
FAQs About Federal/State Roles and Funding
The Biden-Harris administration has increased federal investments 18-fold (from $24M to $432M) for this national priority. Congress has provided the Department of Health and Human Services workforce funding through the American Rescue Plan and the Bipartisan Safer Communities Act. Also, the President’s Fiscal Year 2022 budget request provides additional funding for the Lifeline itself and for other existing federal crisis funding sources. At the state and territory level, in addition to existing public/private sector funding streams, the National Suicide Hotline Designation Act of 2020 allows states to enact new telecommunication fees to help support 988 operations.
There are several existing federal resources that can be leveraged to support 988 implementation. Examples from SAMHSA include the crisis set-aside through the Mental Health Block Grant as well as funding through the Certified Community Behavioral Health Clinic (CCBHC) program. States are also able to leverage Medicaid dollars and State Opioid Response grants. States can find descriptions of these funding sources in the 988 Convening Playbook for States, Territories, and Tribes.
Successful 988 implementation requires ongoing investment and engagement from states and territories. The National Suicide Prevention Lifeline has been available to all states since its launch in 2005. Regarding the transition to 988, states are at varying degrees of readiness for the volume increases expected from moving to the 3-digit code. The Biden-Harris administration has significantly increased the federal government’s contribution to supporting the 988 Suicide & Crisis Lifeline. Most of these funds have gone to Lifeline crisis centers around the country, and to states and territories to build up their local crisis call center workforce. SAMHSA will continue to partner with states, providing a network infrastructure as well as state support through funding opportunities, coordination, and technical assistance.
We recognize the important and timely work of states/territories to prepare for the transition to 988, both now and in the months ahead. To assist, SAMHSA is funding and working with states/territories directly on critical efforts they will need to undertake in support of 988 at their local and community levels. For instance, the National Suicide Hotline Designation Act of 2020 gave states the ability to enact new telecommunications fees to financially support 988 operations, yet very few states have done this so far. Success of 988 will rest heavily upon state, territorial and local leadership in leveraging the resources already available, in addition to making new investments. We will continue to work in close partnership with them to meet the crisis care needs of people across our country.
SAMHSA provided all states and territories an opportunity to apply for funding to support 988 implementation designed to build local 988 capacity; only two states (AK and RI) did not apply, though SAMHSA is in close collaboration with them. In April 2022, SAMHSA awarded nearly $105 million in grant funding, provided by the American Rescue Plan, to 54 states and territories. Regardless of whether a state or territory received funds through that specific grant program, SAMHSA works with all states and territories to partner around enhanced crisis service capacity. HHS has several funding sources to support 988 and integrated crisis care. States, territories, and tribes are encouraged to explore which funding resources are helpful to them. States can find descriptions of these funding sources in the 988 Convening Playbook for States, Territories, and Tribes.
In future years, 988 funding needs will depend on contact volume to the crisis centers and resource needs for full implementation. This may include support to strengthen network operations, strengthening local crisis center capacity, improving public awareness of 988, and improving follow up and linkage to local, crisis care services. Any future federal funding needs will be put forth in subsequent Presidents’ budget requests.
Sources of federal funding for 988 are separate from those of the 911 system. Additionally, the 2020 Hotline Designation Act permits states to apply specific 988 telecommunication fees to support crisis services in a manner that is distinct from fees used to support 911 operations. State and local support of both 988 and 911 are necessary to advance the health and well-being of our communities.
As a component of SAMHSA’s funding, states/territories are required to address outreach and engagement strategies for populations at higher risk of suicide (many of whom are communities of color and historically marginalized groups), including plans for how they will measure effectiveness in improving outcomes and access to services across populations.
essential to invest heavily in network infrastructure in order to strengthen and expand the network to meet the expected increase in demand from transitioning to 988. This includes strengthening national back-up capacity to address expected contact volume while states and territories continue to expand local services.
SAMHSA will provide additional resources for 988 partners to use when communicating about 988 to their audiences, such as content and graphics for social/digital sharing. HHS is working with Congress to ensure federal resources for a national campaign to advertise or promote awareness of 988 to the public.
Anyone who needs suicide or mental health-related crisis support, or who has a loved one in crisis, can connect with a trained counselor by calling, chatting, or texting 988 (if the caller has telephone, cellular or internet service available to them). This is true for Tribal nations, as well. However, SAMHSA recognizes the unique implementation barriers and challenges facing Tribal nations and is committed to supporting coordination efforts with the existing Lifeline infrastructure. SAMHSA expects state and territories to coordinate with Tribal nations to ensure supportive response for tribal contacts to 988, while maintaining respect for Tribal nation sovereignty.
988 will provide an easier way to contact the existing National Suicide Prevention Lifeline. This is an opportunity to strengthen and expand the Lifeline network and to build a robust crisis response system that links callers to community-based providers who can deliver a full range of crisis care services, if needed (like mobile crisis teams or stabilization centers). This more robust system will be essential to meeting crisis care needs across the nation.
Having enough capacity to meet the growing demand for suicide and crisis care needs across the country is the primary focus of SAMHSA’s 988 efforts. This includes strengthening and expanding crisis call center services. It also means improving follow up and linkage to local in-person crisis services and access to community prevention tools and resources, as well as residential and outpatient care.
FAQs About Call Routing, Privacy, Network Functioning
People contacting 988 are not required to provide any personal data to receive services. SAMHSA recognizes the importance and the expectation of privacy when a person contacts 988. The network system has several safeguards to address concerns about privacy.
Any effort to obtain demographic information from those who use 988 will serve three primary purposes: 1) to save lives; 2) to connect people to ongoing supports; and 3) to evaluate system needs and performance, particularly ensuring that gaps and inequities are being addressed.
No. The Lifeline administrator, Vibrant Emotional Health, is a not-for-profit organization with a primary mission to support emotional wellbeing for all people, and it does not sell Lifeline data.
Currently, the Lifeline automatically routes calls by area code to the nearest crisis center (unlike 911, which uses geolocation). As part of the 2020 Designation Act, the Federal Communications Commission submitted a report examining the feasibility and cost of including an automatic dispatchable location that would be conveyed with a 988 call. Within that report, the FCC recommended that Congress require that a multi-stakeholder group be convened to further examine the key issues and collaborate on potential next steps. The FCC held a 988 Geolocation Forum in May 2022 and the agency is actively analyzing the information gathered during that forum.
Currently the calls are routed to the closest center based upon the area code of the cell phone being used. SAMHSA and federal partners are exploring opportunities to address more accurate routing of calls. A counselor may ask a caller for their location in an emergency situation or to provide local referrals.
Although we have made recent progress in reducing overall wait times for Lifeline response, the Lifeline system has been historically underfunded and availability of trained counselors has not been able to keep up with continued increases in contact volume. SAMHSA is focused on improvement of system performance as we transition to 988. This is a key reason for the unprecedented levels of recent funding aimed at strengthening and expanding capacity, and for ongoing efforts to partner with state and territorial crisis centers.
In 2020, Congress designated the new 988 dialing code to operate through the existing National Suicide Prevention Lifeline, and the FCC ordered all 988 calls to be directed to the Lifeline telephone infrastructure. The Lifeline is made up of about 200 local crisis centers across the country, which are equipped to provide 24/7 call, chat, and text services. Across many evaluations, the Lifeline has demonstrated effectiveness in reducing suicidality, and provides a robust foundation upon which to build 988.
Although we have made significant progress in improving Lifeline response rates, scaling the size of the network and building the Lifeline workforce, there is more work to be done. For years, this network has been massively underfunded and under-resourced.
The federal government is responding to these resource challenges with unprecedented levels of funding – representing an 18-fold increase this year from the previous year – and has mounted an all-of-government approach to partner with state and local leaders to improve system capacity and performance and ultimately improve the health of our nation.
However, the federal government cannot do this work alone. Additional state and local investment is needed to further boost the response rates and staffing capacity of call centers facing the greatest demands.
The Lifeline currently requires that all network centers adhere to specific standards regarding Suicide Risk Assessment and Imminent Risk interventions —however, each crisis center also develops their own specific training to meet organizational needs. The Lifeline Core Clinical Training, currently under development, will be a self-paced online training that will cover essential skills for crisis counselors who answer calls/chats/texts within the Lifeline network. Additional training is being developed to address the specific needs of populations at higher risk of suicide.
The Lifeline greeting states that calls may be monitored or recorded for quality assurance purposes. Additionally, crisis centers in the Lifeline network may independently use call recordings for training purposes, dependent on the best practices of the center.
It’s also important to note that people contacting 988 are not required to provide any personal data to receive services. SAMHSA recognizes the importance and the expectation of privacy when a person contacts 988. The network system has several safeguards to address concerns about privacy.
No. Many states and localities operate a significant number of crisis centers separately from the Lifeline network.
The process will not change with the transition to 988. Veterans, Service Members, and their families will be able to call 988 and press option 1 the same as they are able to do by calling 1-800-273-8255. To learn more, please visit https://www.veteranscrisisline.net/about/what-is-988.
Unfortunately, the Lifeline has been historically unfunded and under resourced since it was stood up in 2005. While we have come a long way in recent years and dedicated an unprecedented amount of resources to towards strengthening crisis care in the U.S., it will take time for 988 and the broader crisis response system being built to grow and evolve. One of the most urgent needs involves staffing at crisis centers, and we encourage anyone interested in serving in these critical positions to visit the 988 jobs web page.
July 16, 2022, was a date set by the FCC by which all phone service providers must direct all 988 calls and chats to the existing National Suicide Prevention Lifeline. July 16 was the start of a transition, not the end, and there is still a lot of work to be done. The Biden Harris Administration has made significant strides in strengthening and expanding the existing National Suicide Prevention Lifeline, and we expect the 988 Suicide & Crisis Lifeline will continue to grow and evolve in the coming months and years. We must have our eye on sustainable, long-term change – let us remember, it has taken over 5 decades for 911 and emergency medical services to grow and expand in our country. With 988, we’re poised for a much faster transformation.