Who is most likely to use the 988, the national suicide and crisis lifeline launched on July 16, 2022?
Two studies led by researchers at the NYU School of Global Public Health find both geographic differences and personal factors that shape where people might seek help during mental health crises. For instance, people in western and northeastern states are more likely to have called 988 than those in the South; similarly, Democrats are more inclined to say that they would use 988 than Republicans. In addition, more than 10 percent of calls came from veterans.
The findings, published in JAMA Network Open and Health Affairs, can inform tailored communication campaigns about 988 and other mental health services to better connect people in crisis with resources.
"The success of 988 will ultimately hinge on the extent to which people are aware of 988, have positive attitudes towards it, and reach out to it when experiencing suicidality or another mental health crisis," said Jonathan Purtle, associate professor of public health policy and management at the NYU School of Global Public Health, who led the research.
Mapping 988 use
The 988 lifeline provides a phone, text, and online chat resource for people who are experiencing suicidal thoughts, hopelessness, substance use issues, and other mental health crises. To understand where in the US people are using 988, Purtle and his colleagues analyzed the volume of 988 calls, texts, and chats from the launch of the new lifeline number in July 2022 through December 2024. They then compared the number of contacts with state-level census data.
According to their study, published last month in JAMA Network Open , more than 16 million calls, texts, and chats reached 988 during this 30-month period. Of those contacts, 70 percent were calls, 18 percent were texts, and 12 percent were chats. In addition, 11 percent of the contacts came from veterans, who were transferred to the Veterans Crisis Line.
"It's clear that 988 is a door to entry for many veterans to access mental health services," said Purtle.
The researchers observed geographic differences in 988 use, with higher use in the West and Northeast and lower use in the South. Contacts to 988 varied by state as well; for instance, Vermont had nearly triple the volume of calls, texts, and chats relative to its population compared with Alabama (4.02 contacts per 100 residents vs. 1.44 contacts, respectively).
"Our findings are consistent with other research showing that people in more conservative states are less likely to use 988, but they also provide information about where we should focus on efforts to increase 988 use, especially in the South," noted Purtle.
The study estimates that 1.6 percent of the US population has used 988 in the past year, taking into account an estimate of the frequency with which people contact 988 more than once. While 988 is experiencing substantial volume, its use rate of 2.37 contacts per 100 people is notably less than half of the rate of emergency room visits for people experiencing mental health crises (5.3 visits per 100 US adults in the past year), suggesting that there is an opportunity to increase 988 use.
"We were surprised to see that the rate of emergency room use for mental health crises was about twice the rate of 988 use. We would expect to see the opposite, as calling or texting 988 is easier and lower cost than going to the emergency room," said Purtle.
Where Americans turn in crisis
In addition to studying the geography of where people are using 988, the researchers wanted to understand what resources people are inclined to use when they or a loved one are struggling with mental health issues.
In a nationally representative survey of more than 5,000 adults, the results of which are published July 7 in Health Affairs , the researchers asked people where they would turn for help when facing a mental health crisis: 988, another crisis line, a mental health professional, a friend or family member, or someone in their religious network. Participants were also asked about their recent psychological distress, awareness of 988, and other demographic factors. (The authors note that the survey was conducted in 2023, so it's possible that Americans' awareness and perceptions of 988 have changed since then.)
The researchers found that responses clustered together into five groups:
The "Seek Help Nowhere" group was unlikely to seek help from any source
The "Definitely Not 988, Yes Friends and Family—Distressed" group was not likely to reach out to 988 and had the highest levels of psychological distress
The "Seek Help Everywhere" group was likely to reach out to 988 as well as all the other sources
The "Seek Help Most Places, But Not Religious Network" group was likely to reach out to 988 and all the other sources except their religious network
The "Relatively Indifferent—Not Distressed" group had mixed feelings about the five sources and had the lowest levels of psychological distress
"Given these varied preferences, and differences in levels of awareness about 988, we need to consider the heterogeneity of the US population when designing suicide prevention programs, such as 988, and communication strategies about these programs," said Purtle.
Political party affiliation may also play a role: Republicans said they would likely turn to family and friends during a crisis, but not use 988, while Democrats said they would seek help in most places aside from religious networks, or were indifferent about where they would turn for support.
"Understanding where people are inclined to seek help can help us to craft messages to use in communication campaigns. It's troubling—but also good to know—that many folks with recent psychological distress, who could benefit from calling 988, aren't keen to use it. We need to take this into consideration when communicating about mental health resources," said Purtle.
The research is funded by the National Institute of Mental Health (R01MH131649 and T32MH020004). Additional authors of the JAMA Network Open study include Amanda Mauri of NYU School of Global Public Health and Sachini Bandara and Elizabeth Stuart of Johns Hopkins Bloomberg School of Public Health. Additional authors of the Health Affairs study are Alex Dahlen, Amanda Mauri, and Blake Erickson of NYU School of Global Public Health and Michael Lindsey of NYU Silver School of Social Work.
