By Taylor Blatchford
The Seattle Times
SEATTLE — Calls to 988 have increased steadily in the two years since the number was designated as the new nationwide mental health suicide and crisis lifeline.
Now, the state Department of Health is working to build awareness across the state and ensure Washingtonians know about the three-digit number.
Washington already had a suicide and crisis lifeline, but in 2022 transitioned the longer phone number to 988 as part of a national rollout. When callers call or text 988, they’re connected to a trained crisis counselor. The lifeline supports people thinking about suicide or self-harm, those concerned about someone else, or anyone dealing with emotional stress, substance use or mental health challenges.
Between July 2023 and May 2024, an average of 7,426 Washingtonians called the three-digit number every month. From July 2021 to June 2022, before 988 was designated as the number to call, the state’s suicide and crisis lifeline received an average of 4,467 calls per month.
How have monthly calls to 988 changed over time?
Calls to Washington’s suicide and crisis lifeline have consistently risen in the two years since 988 was designated as the new three-digit number.
State lawmakers and policy experts envision 988 as an entry point to a fully functioning crisis response system that can dispatch mobile crisis teams and bring people to crisis relief centers to get care. But that infrastructure is still being built in Washington and around the country.
“We’re more prepared for calls than we have been, but we’ve got a ways to go,” said state Rep. Tina Orwall, who has sponsored much of Washington’s legislation on 988. “I always say 988 is a teenager. When it grows up, it’s going to be big and robust, just like 911.”
The first two years
Washington got a strong start to implementing 988 when it launched on July 16, 2022. It was one of only four states to initially create a fee, now 40 cents per phone and internet line, to supplement federal funds for the lifeline. Since then, lawmakers have passed more legislation to implement the system and coordinate behavioral health crisis response.
“I think we’re definitely a leader in the country around what we’re doing with 988 and the crisis system in general in our state,” said Lonnie Peterson, the 988 Crisis Systems Manager at the state Department of Health. “It’s all really ambitious, but there’s actually a plan to get us there.”
The additional funding and increase in calls have led to significant growth for Crisis Connections, one of three operators providing 988 services in Washington state. The organization, which handles calls for King County, now has 111 staff members focused on 988, up from 36 when the lifeline launched in July 2022.
“988 has really allowed us to be part of a statewide focus, to finally put time and attention and long needed financial resources to help the whole crisis behavioral system improve,” said Crisis Connections CEO Michelle McDaniel.
Washington has built out its 988 services for specialized populations since the 2022 launch. When callers call 988, they can press 1 for the Veterans Crisis Line, 2 to get support in Spanish and 3 for the LGBTQ+ Youth Line.
Pressing 4 connects them to the Native and Strong Lifeline, which launched in November 2022. The specialized line is staffed by Indigenous crisis counselors who can provide crisis intervention and support while integrating cultural and traditional practices. It’s the only line like it in the country, Peterson said.
The state is still working to integrate 988 with the 911 emergency response system. In March, it began a pilot placing 988 counselors alongside staff who answer 911 calls in three centers, including one in King County. If a call comes into 911 that the dispatcher deems more appropriate for 988, they can transfer the caller directly, Peterson said.
“It’s really helping improve the help-seeker’s experience and also reduce the strain on emergency services in our state,” she said.
Spreading the word
The hotline is only an effective resource if people know it exists, and spreading the word is a work in progress both in Washington and nationally.
Only 23% of Americans say they’re familiar with 988, according to a June 2024 poll conducted by Ipsos for the National Alliance on Mental Illness. In a separate JAMA Network Open study, researchers found that people with serious and moderate psychological distress were significantly more likely to know about 988.
Washington state’s awareness is slightly higher: A Department of Health survey this year found that 37% of respondents were familiar with 988. Among respondents who didn’t speak English as a first language, that number dropped to 20%.
A state website that launched in May and an ongoing publicity campaign are “the first large-scale effort to get awareness out,” Peterson said. The department was told by national leaders not to do too much promotion ahead of the launch in 2022, she said; they were worried crisis centers might be overwhelmed by an influx of calls without enough staff.
The state Department of Health is running ads on social media, streaming and cable TV, digital ads and other platforms through the end of July, with plans for another small campaign at the end of the year. This year, they’re especially focused on reaching veterans, people of color, the agricultural community and people who have substance use disorders.
Building trust in communities of color, who are more likely to fear a response from law enforcement, is also a focus.
More than two-thirds of Black, Hispanic and LGBTQ+ Americans say they would be afraid the police may hurt their loved one or themselves while responding to a mental health crisis, according to the Ipsos/NAMI poll. A majority of people in those same groups say they would not feel safe calling 911 for help if a loved one was having a mental health crisis.
It is possible a call to 988 could lead to a police response, but only in rare cases where there is an imminent risk to someone’s life. Emergency services like 911 are contacted for fewer than 2 percent of 988 calls, according to the Substance Abuse and Mental Health Services Administration.
“Our actions have to show that contacting 988 is going to be safe,” Peterson said. “That’s going to take some time and trust building, but I think we’re moving in the right direction there.”
Next steps and visions of a larger system
There are still kinks to iron out as 988, and the broader crisis response system, continue to grow.
Right now, callers are sent to a local center based on their area code, which sometimes doesn’t match their physical location. The Federal Communications Commission is working on a change that would route 988 calls by the caller’s physical location rather than their area code.
If crisis counselors need to connect a caller to other services or call a mobile crisis team, they then have to transfer the call, McDaniel said.
“This definitely needs to get fixed nationally so it’s a more seamless process for people calling,” McDaniel said. “Ideally, they don’t get transferred around.”
Georouting technology will help callers be routed to their local 988 operator while protecting privacy and not transmitting precise location, the U.S. Department of Health and Human Services said in a news release. It’s expected to launch later this year.
Washington state is also working to streamline communication between its three 988 operators. A new technology platform will help them connect with each other, as well as crisis facilities and mobile crisis teams, Peterson said. The Department of Health will soon launch a request for proposals.
At the legislative level, Orwall hopes to continue focusing on mobile crisis teams, follow-up care, and “postvention": support for loved ones and communities after someone dies by suicide.
“It really is about building a whole new crisis system, because right now the one we have can traumatize people who are in crisis,” Orwall said. “I really see an opportunity to build something better that’s more trauma-informed, more culturally sensitive and more responsive.”
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