How Successful Is the 988 Suicide and Crisis Lifeline in 2023? – Bipolar Burble Blog

As most of you know, the National Suicide Prevention Lifeline morphed into the 988 Suicide and Crisis Lifeline last year. This has broadened its scope and who it aims to serve. Millions have accessed the 988 Lifeline through calls, texts, and messages in the last year. This is extremely impressive. But how successful is the 988 Suicide and Crisis Lifeline at helping people, and would people call 988 again if they were in distress?

Is the 988 Suicide and Crisis Lifeline Useful?

I have written about the Lineline before, highlighting both the positive and possibly negative aspects of it. That said, I’ve always viewed the National Suicide Prevention Lifeline, now the 988 Suicide and Crisis Lifeline, to be a positive thing. People absolutely need a place to go and people to listen to them 24 hours a day, seven days a week, and that is what the Lifeline offers. Indeed, I recommend the 988 Suicide and Crisis Lifeline a lot to people who are in distress. I do this because people on the line are trained professionals. They also aim to be localized to the caller (texter, messager, etc.) and have access to information about the resources that could further help a person in distress. Most people simply don’t have access to that information otherwise. Lifeline workers are in a much better position to help a person in distress than any non-professional you might encounter online or elsewhere.

What Do People Who Have Called the 988 Lifeline Say?

But what do people who have actually called the 988 Suicide and Crisis Lifeline have to say about it?

Their reactions, unfortunately, are not terribly positive, according to a new survey published in the Journal of American Medical Association (JAMA). This survey estimates that only about 30 percent of people with serious distress who called 988 are likely to call the Lifeline again, which is slightly higher than the average of about one-quarter being likely to call again if in distress (from here). (I do think at least part of this has to do with the growing pains of serving so many more people; of course, I don’t know that because we don’t have any information on why people wouldn’t call back.)

What Would Success Look Like for the 988 Suicide and Crisis Lifeline?

Let’s dream about what success for the 988 Lifeline would look like.

I think the 988 Lifeline would be 100 percent successful if everyone who called/texted/messaged 988 were referred to appropriate resources and, so, never had to call 988 again. In other words, in theory, 988 would actually receive fewer calls over time as the people who called in were referred to appropriate resources.

This, of course, is a pipe dream. The 988 Lifeline can do everything right, but people still may not access the right resources. The resources may not be available. The resources may be too expensive. The resources might not work for them. And so on. There are 1000 reasons why the 988 Lifeline can do everything right, and people still need to rely on them.

So, we need a more reasonable version of success. In the simplest terms, these questions matter:

1. Does the 988 Suicide and Crisis Lifeline help people when they call as judged by the caller?
2. Would people who have called the 988 Suicide and Crisis Lifeline call again if they were in distress?

There are other success metrics for the 988 Lifeline, too, but I would say those two are pretty important.

We have an answer to the second question, but let’s take a look at the first question.

Does the 988 Suicide and Crisis Lifeline Help People When They Call?

Because this incarnation is new, research isn’t available for the last year. That said, the National Suicide Prevention Lifeline was around for years, and it has been studied. Here is some of what we have learned from the research. (Thanks to The Journalist’s Resource for such a great research round-up.)

In one study, there were 3,000 callers from a representative sample of crisis centers interviewed. It was found that of seriously suicidal individuals calling suicide hotline services, eight percent were actually in the midst of a suicide attempt, and 58 percent had made a prior suicide attempt. Callers reported significant reductions in self-reported crisis and suicide states by the end of the call (from here).

In a 2017 study, it was found that nearly 80 percent of the interviewed clients who had used the National Suicide Prevention Lifeline reported that the intervention stopped them from killing themselves, and 91 percent said it kept them safe. Individuals at higher risk of suicide at the time of their calls to the Lifeline perceived the follow-up intervention to be more valuable (from here).

In 2021, a study found that by the end of the chat with a Lifeline Crisis Chat responder, two-thirds of the people who reached out and were suicidal reported that the correspondence had been helpful, and 45 percent reported being less suicidal, while 30 percent said they felt the same as when they began the chat, and 12 percent said they were more suicidal (from here). These are incredible numbers. In just one conversation, almost half of suicidal people were helped. That’s a number to trumpet. (Of course, other services need to pick up from there to sustain that benefit and build upon it. I suspect we fall down greatly in that respect; see the following paragraph.)

In a 2012 study, to no one’s surprise, the negative perceptions people have of mental health resources were highlighted. Nearly 83 percent of the callers reported having received mental health treatment at some point in their lives, and 46 percent were in treatment at the time of their call. However, only 35 percent of callers referred to mental health resources followed through with the referral. Barriers to accessing mental health services included denying the severity of one’s mental health problem, financial problems, and not having health insurance. A third of callers reported a lack of trust or negative experience with mental health providers as their reason for not accessing mental health care after the call (from here). (Note that negative perception is distinctly different than stigma — the latter being widely cited as the main barrier to care, which isn’t borne out in studies.)

Not everything is so rosy, though. A New York Times data analysis from this year found that 18 percent of calls in the first half of the year went unanswered (that’s about 180,000, which boggles my freaking mind; from here). Just to do the scary math, if other stats here are correct, that means that about 14,400 people were actually in the midst of a suicide attempt and didn’t have their call answered.

I believe we can say that a lot of the data is going to be similar for the calls answered by the 988 Suicide and Crisis Lifeline as it was for the previous incarnation when you take into account the severity of distress. Previously, more callers showed greater distress; now, due to public awareness campaigns, 988 answers many more calls, and a greater proportion show lesser distress. (Which is not a bad thing, by the way. It’s easier to tackle a problem before it becomes a catastrophe.)

Can the 988 Suicide and Crisis Lifeline Be Successful?

Not everyone who calls the 988 Suicide and Crisis Lifeline is going to be helped. Not everyone is even going to get their call answered. That said, the studies show that the National Suicide Prevention Lifeline was successful at saving people’s lives, and there’s no reason to think that the 988 Suicide and Crisis Lifeline will be anything but successful as well, even if there are growing pains at this point. There are definitely improvements that need to be made. I think that’s clear. And I’m a bit biased, but I believe the single person that you save makes your effort a success.

But . . .

We need to do more. Trained, empathetic, dedicated individuals are working as hard as they possibly can to save lives, but they are a stopgap at best. To be honest, it should be the exception, not the rule, that a person who is in great distress needs to call a lifeline. It should be the case that people in great distress, and certainly people who are suicidal, can get access to real resources that can really help them over time. A person on the phone or online is never going to be able to sew up a bullet wound. All they can do is slap on a Band-Aid and point you in the direction of a surgeon. But if the surgeons aren’t available, if the surgeons ignore your bullet wound, if you’ve been hurt by surgeons in the past, no amount of Band-Aids will save you.

Image: Close-up portrait of sad businesswoman talking by wired phone with paper napkin at office – depositphotos.com

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