The new 988 hotline has been criticized for potentially prompting a police response, but supporters say it’s misguided

The 988 Suicide & Crisis Lifeline number, a new national mental health helpline, has been criticized on social media since its launch earlier this month for being too closely linked to the 911 system, to which it claims to be an alternative, which some activists have said for mental health discourage people from calling it.

In viral posts that have received hundreds of thousands of impressions over the past two weeks, critics on Twitter and Instagram have said that calling 988 – which replaced the National Suicide Hotline – leads to regulatory interference, non-consensual treatment and an invasion of privacy could .

But mental health advocates and government officials say much of the skepticism stems from misinformation. For example, the line cannot track the precise location of a caller. And only a small portion of calls are routed to law enforcement.

John Draper, the executive director of the 988 hotline, called the criticism “an artifact of many, many years of deserved suspicion” for mishandling public health crises as public safety crises. “That’s really what the 988 should change,” he said.

The hope is that the new three-digit Lifeline number will be easier to remember than the 10-digit National Suicide Prevention Lifeline in times of crisis, and that it will provide a response from qualified mental health professionals, rather than law enforcement or emergency services in response from 911 calls .

Fewer than 2% of calls to Lifeline result in a 911 referral from the person answering the call, and less than half of referrals to emergency services are made without the caller’s consent, Draper and Department of Health and Human Services officials said . Administration of Substance Abuse and Mental Health Services or SAMHSA. This calculation includes calls to 988 and the 1-800 number. So far, his system is unable to distinguish between the two.

“There are some cases, around 2% of the time, where the person at the end of the call is at such a high risk that we believe there is a possibility, even a likelihood, that they will die if we don’t do. I won’t do anything,’ Draper said. “Usually it’s because the person is like, ‘Yes, please call 911,’ or ‘Help me call 911 because I’m going to die.'”

Up to 80% of calls, chats or texts are resolved through the first contact, a SAMHSA official said. The others typically receive support from mobile crisis services — mental health units designed to meet with people and de-escalate a crisis — and other local support.

Misty Vaughn Allen, whose tenure as Nevada’s suicide prevention coordinator was nationally acclaimed for lowering her state’s suicide rate, said she continues to work with law enforcement on crisis interventions and suicide prevention training and efforts, but stressed that “the whole thing The point of 988 is to withdraw from 911.”

“I haven’t called 911 in years because I believe the best response is to listen and keep people out of an emergency room, especially when we can help them find that support system and safety plan,” she said.

Still, there are concerns that there is not enough infrastructure to meet the country’s mental health needs without triggering a response from paramedics and forcing people to an emergency room or treatment facility.

A critical Instagram post, which garnered almost 250,000 likes, said: “988 is not friendly. Don’t name it, don’t post it, don’t share it without knowing the risks’, which have been listed as ‘police intervention, degrading involuntary treatment in emergency rooms and psychiatric hospitals, use of medical force to punish the ‘uncooperative” or distressed patients, forced drug use, crushing medical debt and life-changing trauma.

The post was created by Liz Winston, a peer support counselor in New York City, who said she found calling the suicide hotline before 988 unhelpful and impersonal when she tried to use it in 2014 . She said she also voluntarily sought help in an emergency room during a mental health crisis and received no help. Instead, she said she experienced trauma and received a $6,000 bill.

“I’ll be very frank with you: I don’t think people should call 988 unless they are fully prepared for hospitalization and know what a psychiatric hospitalization is like,” she said.

Winston said her view of 988 would only change if mental health laws, which allow involuntary admission to psychiatric centers in some cases, were changed. She said it was very difficult to trust the program when she and others had previously failed in mental health crises.

The 988 concern isn’t a black-and-white issue, said Craig Bryan, the director of the suicide prevention program at Ohio State University’s Wexner Medical Center, but treating it that way on social media “makes it really hard for people to weigh the pros and cons.” and disadvantages.”

“It’s not exactly a place where nuance and the gray area between extremes are easily discussed,” he said.

Still, even low intervention rates — like the 2% figure — are a problem, said Emily Krebs, a Fordham University assistant professor who studies suicide and shared criticism of 988 on Twitter.

“Further studies show that the risk of suicide attempts and deaths is higher after receiving this non-consensual care,” they said over the phone. “So we could stop a crisis in a moment, but we’re not fixing a problem.”

Another issue, Krebs said, is privacy. Many fear the 988 system could geolocate a caller, a feat the line doesn’t currently have — although 911 does. However, a SAMHSA official said the Federal Communications Commission assembled a panel of stakeholders to discuss whether to allow 988 some sort of geolocation.

The FCC is still deliberating, the official added.


Geolocation would ensure the right local services could be more easily connected to callers, Draper said. While precise location is not required, it would all be an upgrade from the current system, which connects callers via their area code to services that increasingly do not accurately reflect a person’s actual location due to the proliferation of cell phones.

Both Bryan and Krebs suggested that one solution might be to screen callers and give them the option to choose to share their location and be connected to a local call center.

Officials stressed that 988 was just a first step and there were further plans to expand to provide a continuum of care outside of current emergency services, but Krebs and Winston said the hotline appeared to be launched before all the necessary infrastructure was in place.

In 2020, bipartisan legislation in Congress called for the introduction of the 988 emergency number, but left funding for the infrastructure to the states. This has led to a patchwork system.

Krebs said further transparency and communication about what is planned would help set expectations and provide insight into the program.

“I’m afraid we’re getting into what all politicians are ridiculed for, which is this promise of hope and change and recovery without a clear plan for how it’s going to happen,” they said. “I’m sure that plan exists. I’m sure HHS and SAMHSA are actively working on this. But it would be a big step to deal with it more transparently and to be clear to the public.”

Draper said there is a plan, but it will take time and more resources in every state across the country to get there. Right now there aren’t enough alternatives to emergency services because the 911 system is so vast, but he said he remains committed to ensuring that 988 has “a continuum of service” that matches 911.

“This is the doorstep to a transformative moment in behavioral health care for the country. That will take time to develop,” he said. “But what we’re seeing is tremendous stakeholder engagement, investment and interest in building that out.” The new 988 hotline has been criticized for potentially prompting a police response, but supporters say it’s misguided

Fry Electronics Team

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