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A Simple Way to Make the Suicide Hotline More Effective

The 988 Suicide and Crisis Lifeline provides comprehensive support for Americans who face acute mental health challenges. Congress is considering ways to tailor services more strategically.

Taking a 988 call in Tampa Bay
Intervention specialist Ariana Diaz handles a 988 call during National Suicide Prevention Week at the Crisis Center of Tampa Bay, Fla.
Jefferee Woo/TNS
In Brief:
  • Since its implementation in 2022, the 988 Lifeline has handled nearly 10 million calls.

  • Currently, 988 calls route to the agencies associated with the caller's area code, not their actual location. This limits cities' and counties' ability to meet mental health needs.

  • Legislation in Congress and a proposed FCC rule would change the way these calls are routed to connect people in crisis with local care.

  • Since its launch in 2022, almost 10 million Americans have made use of 988, the National Suicide and Crisis Lifeline. These Americans generally call because they’re afraid they or a loved one may harm themselves. The service offers an alternative to calling 911, so people experiencing mental health distress are not interacting with law enforcement agencies that may not be equipped to help them.

    The 988 Lifeline “connects the different elements of mental health services and builds out the full continuum of crisis care response," says Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness (NAMI).

    However, there's one factor that limits 988's effectiveness: the lack of proper geo-routing. Unlike 911 calls, 988 calls are routed based on the area code of the person calling, not their current location. In an era of cellphones and other portable numbers, that means a lot of calls are being answered on the other side of the country, not nearby agencies able to connect people with local resources.

    Although 80 to 90 percent of 988 callers get the help they need over the phone, Wesolowski says, there are significant numbers of people with more serious problems that aren't "necessarily going to get the best care."

    Truly Local Resources

    The lack of guaranteed local connection has made some county officials hesitant to drive a bigger marketing push for 988 in their areas. “This has led to us at the county being hesitant to overly promote 988,” says Kyla Coates, mental health deputy for Los Angeles County Supervisor Janice Hahn. “We don't want people calling and having this experience and then being turned off of 988 forever.”

    Los Angeles County has had a robust mental health campaign for over 50 years. The county has maintained a local number for mental health assistance and a fleet of trained mental health professionals to make emergency house calls. The 988 Lifeline was supposed to help increase residents’ access to timely care in a crisis. Coates says geo-routing "would absolutely solve" what she describes as the current "tricky situation."

    That’s why several members of Congress have introduced legislation to improve 988, including California Sen. Alex Padilla and New York Reps. Marc Molinaro and Paul Tonko. These bills, which have bipartisan support, would encourage a shift in how calls to 988 are routed, using the caller’s current location and cellphone towers. “911 calls are rerouted to local call centers,” Rep. Molinaro said in a statement. “There’s no reason we can’t do the same for 988.”

    In addition to the proposed legislation, the Federal Communications Commission (FCC) is pursuing a different approach to geo-routing. On March 21, FCC Chair Jessica Rosenworcel announced a proposal that would require telecommunications companies to use geo-routing. FCC rules are adopted following a period of public comment, so it may take several months before this rule is adopted.

    Even with an uncertain timeline ahead, mental health advocates are excited to see lawmakers and the FCC step forward on this issue. They believe that 988 geo-routing will help local public mental health efforts address and support Americans in crisis more strategically.

    "We want to keep people safe," NAMI's Wesolowski says. "We want to keep them in the community," referring to the way people in crisis are often removed from familiar spaces by being hospitalized or arrested as a result of their symptoms. “By bringing all local resources to bear [with 988]," she says, "we can better help people avoid those tragic outcomes.”

    If you know someone who is thinking about suicide, help is available at 988, the Suicide and Crisis Lifeline.
    Zina Hutton is a staff writer for Governing. She has been a freelance culture writer, researcher and copywriter since 2015. In 2021, she started writing for Teen Vogue. Now, at Governing, Zina focuses on state and local finance, workforce, education and management and administration news.
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