988: What Social Workers Need To Know About the New 3-Digit Crisis Line Number

by Jonathan B. Singer, PhD, LCSW

     For decades, the outgoing message for all mental health providers and organizations included the phrase, “If this is an emergency, please hang up and call 911.” As of July 16, 2022, there’s another 3-digit number that social workers should know about: 988. According to Shelby Rowe, Director of the Suicide Prevention Resource Center, “988 is a new, easier to remember 3-digit number for the National Suicide Prevention Lifeline (NSPL), but it is not a new service. In most parts of the country, the same organizations who have answered calls to 1-800-273-8255 will be answering calls to 988.” If you’re familiar with the Lifeline, you’re familiar with 988. You can call, text, or chat with 988 and be connected with a crisis worker.

     Social workers and agencies should update outgoing messages and email signatures to include, “Call 911 for medical emergencies and 988 for mental health and suicide crises.” Becky Stoll, LCSW, Vice President of Crisis and Disaster Management at Centerstone, recommends that “unless one needs to go to an emergency room for a medical emergency (including a potentially injurious suicide attempt), they are better off reaching out to 988 to get their needs met.”

How does 988 work?

     When you dial 988, you’re connected to an automated system that invites you to press 1 for Veteran Crisis Line, press 2 for crisis services in Spanish, or stay on the line to be connected to a local crisis center (in English). If no number is pressed, calls are routed to a local crisis center based on the caller's area code. If no local crisis center is available, the call goes to a backup center that could be located anywhere in the United States.

     See the NSPL infographic for more details.

988 crisis services vary within and between states

     Unlike 911, which is a dispatch service that sends out EMS, Fire, and Police, 988 is a crisis line that connects someone via text, chat, or call to a crisis worker. According to Jess Stohlman-Rainey, former Director of Program Development at Rocky Mountain Crisis Partners, every state’s crisis services will be different. There are some states with several crisis centers (e.g., Illinois, New York, and California) and others with one for the entire state (e.g., Montana). Some examples of the variety of crisis centers include:

• centers that are staffed by highly trained volunteers in call centers that are not part of a mental health delivery system,
• centers staffed by licensed professionals with immediate access to mobile crisis response for those who need face-to-face services and crisis residential facilities for next-level care, and
• centers that are located in the same room that serves 911 (i.e., 988 and 911 are co-located), and whose crisis workers are embedded with police units. 

     If you’re not familiar with your local crisis centers, Jess recommends looking up the local crisis center (988 has them listed by state: https://988lifeline.org/our-crisis-centers/), checking their website for information, and/or contacting the business office. DO NOT call/text 988 to test out the system, because the rollout is expected to overwhelm an already under-resourced system.

988 is not 211 or 311

• 211 (https://en.wikipedia.org/wiki/2-1-1) provides information and referral services to health, human, and social service organizations. The podcast 99% Invisible has a fascinating episode about 211 and homeless services: https://99percentinvisible.org/episode/according-to-need-chapter-2-the-homelessness-hotline/.
• 311 (https://en.wikipedia.org/wiki/3-1-1) provides information about non-emergency city/municipal services, such as trash pick-up. Atlanta, Georgia, has an innovative program in which 311 partners with a Policing Alternatives & Diversion Initiative to facilitate outreach to individuals experiencing concerns related to mental health, substance use, or extreme poverty. 

Gaps in services

     Social workers have a vested interest in making sure Public Enemy doesn’t have a reason to write and release a song called “988 is a Joke.” There are several notable gaps in 988 services that, if we know about them, we can make sure we’re advocating for them to be addressed.

• Substance use services: Although 988 advertises that it will respond to substance use crises, most crisis workers who answer 988 calls/texts/chats are not trained in assessing and responding to substance-related concerns. This is part of a long-standing division between the training and funding for mental health and substance related services.
• LGBTQ+ services: Although The Trevor Project is part of the 988 system, it is the only service that has an explicit focus on LGBTQ youth. Trans Lifeline notes that 988 requires centers to use geolocation and active rescue (i.e., law enforcement) when there is imminent risk, which conflicts with their abolitionist mission. Thus, there are no trans-specific services on 988 at the moment.
• Deaf and hard of hearing: John Draper, Lifeline’s Executive Director, told CNN that there is a pilot project planned for fall 2022 to provide services for deaf and hard of hearing.
• Peer support: According to Jess Stohlmann-Rainey, one of the limitations of the Lifeline (old or new number) is that there is no way to be automatically connected to peer support. Access to peer support is written into the 988 legislation and supported by SAMHSA, but current technology does not allow someone to select peer support before being connected with a crisis center. You can advise your clients that if they want to reach peer support, they need to request it after the crisis worker answers the call.
• Staffing: 988 centers are underfunded and understaffed. According to Becky Stoll, “There are jobs available at 988 Crisis Call Centers across the country. Many of them are remote and pay well.” The SAMHSA website has links to job and volunteer opportunities at crisis centers around the country. See: https://www.samhsa.gov/find-help/988/job

Final thoughts

     It took nearly 30 years for most Americans to have access to 911 services. 988 was established and rolled out in less than 4 years. Shelby Rowe told me, “With 988, there is new potential to provide access to compassionate, timely and collaborative care for ALL Americans experiencing crisis, regardless of age, race, ethnicity, sexual orientation, gender identity, income, housing status, physical or intellectual ability. We must not settle for anything less. Our work is not done until everyone has access to the vision of 988: someone to talk to, someone to come, and somewhere to go.” Implicit in her comment is the fact that social workers have a vested interest in making this vision a reality.

Jonathan B. Singer, PhD, LCSW, is Professor at Loyola University Chicago School of Social Work, past-President of the American Association of Suicidology, co-lead for the Grand Challenge “Harness Technology for Social Good,” co-author of the best-selling Suicide in Schools, and founder and host of the award winning Social Work Podcast.