As most of you know, the National Suicide Prevention Lifeline morphed into 988 Lifeline of suicide and crisis last year. This has broadened its scope and who it aims to serve. Millions have accessed 988 Lifeline through calls, texts and messages over the past year. This is very impressive. But how successful is 988 Suicide and Crisis Lifeline in helping people and would people call 988 again if they were in danger?
Is 988 Suicide and Crisis Lifeline useful?
I’ve written about the Line before, highlighting both its positive and possibly negative aspects. That said, I’ve always viewed the National Suicide Prevention Lifeline, now the 988 Suicide and Crisis Lifeline, as a positive thing. People definitely need a place to go and people to listen to them 24 hours a day, seven days a week, and that’s what Lifeline provides. Indeed, I highly recommend 988 Suicide and Crisis Lifeline to people in danger. I do this because the people on the line are trained professionals. They also aim to identify themselves to the caller (texter, texter, etc.) and access information about resources that could further help a person in distress. Most people simply don’t have access to this information otherwise. Lifeline workers are in a much better position to help a person in distress than any non-professional you may meet online or elsewhere.
What are people who have called 988 Lifeline saying?
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 new research published in the Journal of the American Medical Association (GLASS). This research estimates that only around 30 per cent of people in severe distress who called 988 were likely to call Lifeline againwhich is slightly higher than the average of about a quarter who are likely to call again in case of danger (from here). (I think at least part of this has to do with the growing pains of serving many more people; of course, I don’t know because we don’t have any information on Why people wouldn’t call back.)
What would success look like for 988 Suicide and Crisis Lifeline?
Let’s dream what success would look like for 988 Lifeline.
I think 988 Lifeline would be 100 percent successful if everyone who called/texted/messaged 988 was referred to the appropriate resources and therefore never had to call 988 again. In other words, theoretically, 988 would receive in actually fewer calls over time as callers were referred to appropriate resources.
This, of course, is a dream. 988 Lifeline can do everything right, but people may not have access to the right resources. Resources may not be available. Resources can be very expensive. Resources may not work for them. And so on. There are 1000’s of reasons why 988 Lifeline can do everything right and people should still rely on them.
So we need a more reasonable version of success. In the simplest terms, these questions matter:
- Does 988 Suicide and Crisis Lifeline help people when they call as judged by the caller?
- Would people who have called 988 Suicide and Crisis Lifeline call again if they were in danger?
There are other metrics of success for the 988 Lifeline, but I would say these two are very 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 line help people?
Because this incarnation is new, research is not available for the last year. That said, the National Suicide Prevention Lifeline has been around for years and has been studied. Here’s some of what we learned from the survey. (Thanks to The Journalist’s resource for such a large investigation.)
In one study, 3,000 callers from a representative sample of crisis centers were interviewed. It found that of severely suicidal people who called suicide hotline services, eight percent were actually in the middle of a suicide attempt and 58 percent had made a previous suicide attempt. Callers reported significant reductions in self-reported crisis and suicidal states by the end of the call (from here).
In a 2017 study, it was found that approx 80% of clients surveyed who had used the National Suicide Prevention Lifeline reported that the intervention prevented them from killing themselves and 91% said it kept them safe. People at higher risk of suicide at the time of their Lifeline call felt that the subsequent intervention was more valuable (from here).
In 2021, a study found that by the end of a conversation with a Lifeline Crisis Chat operator, Two-thirds of people who reached out and were suicidal reported that the mail was helpfuland 45 percent reported being less suicidalwhile 30 percent said they felt the same as when they started the conversation and 12 percent said it was more suicidal (from here). These are incredible numbers. In just one conversation, almost half of the suicidal people were helped. This is a trumpet number. (Of course, other services have to pick up from there to maintain this benefit and leverage it. I suspect we’ve fallen far behind in that regard. see next paragraph.)
A 2012 study, to no one’s surprise, highlighted the negative perceptions people have of mental health resources. Nearly 83 percent of callers reported receiving 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 were referred to mental health resources and followed up on the referral. Barriers to accessing mental health services included denial of the seriousness of the mental health problem, financial problems, and lack of health insurance. One-third of callers cited a lack of trust or a negative experience with mental health providers as the reason they did not access mental health care after the call (from here). (Note that negative perception is distinctly different from stigma—the latter is widely cited as the main barrier to care, which is not borne out in studies.)
It’s not all so rosy, though. ONE New York Times analysis of data from this year found that 18% of calls in the first half of the year went unanswered (it’s about 180,000, which boggles my freaking mind. from here). Just to do the scary math, if other statistics here are correct, that means about 14,400 people were actually in the middle of a suicide attempt and didn’t get their call answered.
I think we can say that much of the data will be similar for the calls answered by 988 Suicide and Crisis Lifeline as it was for the previous incarnation, when you consider the severity of the distress. Previously, more callers presented more distress. Now, due to public awareness campaigns, 988 is responding to many more calls and a greater proportion are less distressed. (Which isn’t a bad thing, by the way. It’s easier to deal with a problem before it becomes a disaster.)
Can 988 Suicide and Crisis Lifeline be successful?
Not everyone who calls 988 Suicide and Crisis Lifeline is going to be helped. Not everyone is even going to get their call answered. That said, studies show that the National Suicide Prevention Lifeline has been successful in saving lives, and there’s no reason to believe that the 988 Suicide and Crisis Lifeline will be anything but successful, even if there are growing pains at this point. There are definitely improvements to be made. I think it’s clear. And I’m a little biased, but I think the one person you save makes your effort a success.
But . . .
We must do more. Trained, empathetic, dedicated individuals work as hard as they can to save lives, but at best they are an inhibiting vacuum. To be honest, it should be the exception, not the rule, that a person in great distress should call for a lifeline. It should be the case that people who are in great distress, and certainly people who are suicidal, can access real resources that can really help them over time. A person on the phone or on the internet is never going to be able to stitch up a bullet wound. All they can do is slap on a cord and refer you to a surgeon. But if surgeons aren’t available, if surgeons ignore your bullet wound, if you’ve been hurt by surgeons before, no amount of Band-Aids will save you.
