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  • The National Suicide Prevention Lifeline number became ‘988’ on July 16 to make help-seeking in a moment of crisis more accessible.
  • Experts have expressed concern that the Lifeline has already struggled to meet demand due to the increase in youth suicide rates during the COVID-19 pandemic.
  • Suicidality is especially high among Youth of Color and marginalized groups, including LGBTQ youth.
  • Increased federal funding to 988 networks across the U.S. may help ensure call centers are prepared to handle the expected surge in calls to the new hotline.

Suicide and suicidal ideation are major public health crises that can affect anyone — particularly young people.

According to the National Institute of Mental Health, suicide is the 12th leading cause of death in the United States and the second leading cause of death among younger individuals ages 10 to 34.

The U.S. Surgeon General and the American Academy of Pediatrics have acknowledged the growing youth mental health crisis that’s been exacerbated by the COVID-19 pandemic and disproportionately affected Youth of Color and LGBTQIA+ youth.

When former president Trump signed the National Suicide Hotline Designation Act of 2020 into law, plans were set in motion for a mental health emergency hotline.

On July 16, the National Suicide Prevention Lifeline became “988,” replacing the previous 1-800-273-8255 (TALK) number. However, the original 11-digit number will still work.

President Biden has awarded $105 million to states and territories across the U.S. to strengthen crisis call center services to prepare for the transition to 988 as part of the administration’s mental health strategy.

As the National Suicide Prevention Lifeline number becomes 988, getting help in a crisis could become more accessible — but experts have expressed concern that not all call centers are prepared.

An April 2022 report from the Centers for Disease Control and Prevention (CDC) — the Adolescent Behaviors and Experiences Survey — shows that 44% of teens in the United States feel persistently sad and hopeless, an increase from 37% in 2019. In addition, research from 2022 shows that the overall teen suicide rate had increased during the pandemic within the 14 states that were studied, although in certain states, it did decrease.

Another CDC report shows that while the overall suicide rate in the U.S. decreased in 2020 for the second consecutive year, the decline was not universal.

Suicide rates increased among youth and young adults, Black and Hispanic males, and multi-racial females during the pandemic. And data from the Trevor Project, a suicide prevention organization for LGBTQ youth, suggests that suicidal ideation among LGBTQ youth has trended upward over the past 3 years.

The impact on LGBTQIA+ youth

The Trevor Project’s 2022 National Survey on LGBTQ Mental Health shows that nearly half of all LGBTQ youth seriously considered suicide in the past year. Transgender and nonbinary youth and LGBTQ Youth of Color were more likely to attempt suicide than their LGBTQ cisgender or white peers.

The survey indicates that LGBTQ youth who experienced anti-LGBTQ victimization — being physically threatened or harmed, discriminated against, or subjected to conversion therapy — were twice as likely to attempt suicide in the past year compared to those who did not have these experiences.

And prior research from the Trevor Project shows that LGBTQ youth are more than 4 times as likely to attempt suicide compared to their peers.

Preston Mitchum, director of Advocacy and Government Affairs at the Trevor Project, told Healthline that LGBTQ young people are not inherently prone to suicide risk but are placed at higher risk because of how they’re mistreated and stigmatized in society.

“Bullying, discrimination, family rejection, lack of social support, and conversion ‘therapy’ attempts — these are all common risk factors that are unique to LGBTQ youth and can contribute to negative mental health outcomes,” Mitchum said.

There is growing concern that the National Suicide Prevention Lifeline, which is already inundated with calls, will be overwhelmed as it transitions to 988.

June 2022 research from the National Academy for State Health Policy (NASHP) assessed state-by-state readiness for the rollout of 988 and found that only 21 states had enacted legislation to implement and provide funding for the new hotline.

Jodi Manz, project director with the Behavioral Health, Aging, and Disability team at NASHP, told Healthline that as states have been working to enhance their crisis systems and call center capacity, some still have legislation or budgeting items in process.

“Because there are federal dollars to support initial investments and planning in states, some other states may not have seen this shift as an immediate funding need in their state budgets this year,” Manz said.

According to Manz, enhancing mental health crisis services for readiness — including call centers — is not new for states and has been a major priority for state behavioral health systems in recent months.

“Some states have developed sophisticated call center capacity over the last several years and have invested early in enhancing those in preparation for the shift to 988,” she said. “For states that are in process of developing that capacity, increases in call volume will likely be a challenge, though no matter what state a person is calling from, the back end of the system can route calls to the National Suicide Hotline when someone dials 988.”

According to Manz, states could enhance call center preparedness by:

  • recruiting and retaining qualified personnel to provide crisis services
  • ensuring sustainable funding for call centers

In a statement provided to Healthline, Kimberly Williams, president and CEO of Vibrant Emotional Health, the nonprofit administrator of the National Suicide Prevention Lifeline, said that funding had increased in recent months to support the capacity growth and expansion of the Lifeline system in preparation for the transition to 988.

“These funds will be used to fund nationalized services in the Lifeline network, which includes the national backup network, chat and text network and Spanish subnetwork, as well as to continue developing the infrastructure and services needed to support the 988 network,” Williams said. “Lifeline backup and nationalized services are an important and proven component of ensuring a mental health safety net, particularly when there are demand surges.”

Still, NASHP data show that several states have passed legislation that charge telecom fees, which could pose a barrier to some callers.

Robert Gebbia, chief executive officer of the American Foundation for Suicide Prevention (AFSP), told Healthline there might be an adjustment phase before the 988 network is sufficiently equipped to handle the expected surge in demand.

“We hope the recent infusion of federal funds will accelerate the process to be ready for call increases and work toward other critical components key to reimagining an optimal crisis mental health response system,” Gebbia said.

Similar to 911, dialing 988 could make it easier in a moment of crisis to access help and support.

According to Williams, the switch to a 3-digit number will strengthen and expand the existing Lifeline network of over 200 crisis centers across the country. “It creates an easy access point to reach a trained crisis counselor for anyone in emotional distress,” Williams said.

Of course, with improved accessibility comes a surge in demand. Funding call centers can help ensure that more trained personnel are available to answer calls and ultimately save lives.

“The success of the hotline and the value it brings to callers largely depends on whether or not the local call centers can absorb the spike in calls,” Gebbia said.

According to Gebbia, Lifeline’s call volume has increased 14% annually since its 2005 launch. But experts say this number is expected to increase as pandemic-related emotional stressors continue to affect the nation’s mental health.

If effective, 988 will help more people experiencing suicidal ideation access the support and care they need.

“In moments of crisis, every second counts,” Mitchum said. “However, we must keep working to ensure that 988 is also accessible and equitable for the most marginalized communities — this includes transgender and nonbinary youth and Youth of Color, who often face greater discrimination, stigma, and mistreatment in health care settings.”

How does it work?

When a person calls 988, Gebbia explained they’ll be met with an automated greeting with options for Spanish speakers and veterans.

Next, their call is routed to the closest crisis center based on their area code and is connected to a trained counselor.

According to Gebbia, around 98% of calls are de-escalated over the phone with a counselor, and only 2% require an emergency dispatch.

A recent Trevor Project survey on U.S. adults’ knowledge of suicide prevention and awareness of the new 988 number found that nearly 7 in 10 adults feel knowledgeable about suicide prevention.

With the right resources and support systems in place, suicide is preventable. Identifying those who may be at risk for suicide is the first step in ensuring that help and support can be made available.

Suicide prevention resources, such as those offered by the AFSP, include educational materials and lists of organizations that provide mental health care (AFSP is not a crisis call center).

But youth suicide prevention may also depend on strategies employed at federal and public health levels.

For instance, the U.S. Preventive Services Task Force recently announced that clinicians should begin screening all children ages 8–18 for anxiety. The American Academy of Pediatrics recommends screening all children ages 12 and above for suicide risk. The Biden administration has also pledged $1 billion in funding to bring more counselors, psychologists, and social workers into schools to work directly with students.

Yet, for People of Color and marginalized groups, it may take more than federal funding to solve systemic, structural issues that burden children and their families. These changes may include prioritizing:

  • affordable housing
  • accessible healthcare
  • job opportunities
  • reducing debt

Strategies for the LGBTQIA+ community

Both Congress and President Biden have called for 988 to have specialized services for groups at the highest risk for suicide, including LGBTQ youth.

And for the LGBTQIA+ community at large, acceptance of their identities can be life-saving.

June2022, research from the American Psychological Association (APA) found that fewer LGBTQ youth attempted suicide in states with hate crime laws that protect the LGBTQ population. And Trevor Project research from 2019 found that LGBTQ youth with at least one accepting adult were 40% less likely to attempt suicide.

According to Mitchum, LGBTQ youth who live in an accepting community, have access to LGBTQ-affirming spaces or feel a high level of social support from family and friends report significantly lower rates of attempting suicide.

“We need lawmakers to help combat anti-LGBTQ victimization by implementing LGBTQ-inclusive policies and nondiscrimination protections, as well raising awareness on LGBTQ issues to foster broader acceptance and understanding,” Mitchum said.

In addition, a June 2022 research brief from the Trevor Project highlights how resilience can reduce suicidality in LGBTQ youth and promote mental well-being.

Mitchum stressed that all current and future Lifeline counselors should be trained in LGBTQ cultural competency to understand the unique challenges and experiences that LGBTQ young people face, which, in turn, may help promote resilience.

“Ideally, those specialized services will include an integrated voice response option, so that young LGBTQ callers can be transferred to groups like The Trevor Project, where we have our own specially trained counselors,” Mitchum said. “We are committed to working closely with the federal government to ensure that they follow through with the full funding and implementation of these measures.”

Resources at the Trevor Project

The Trevor Project crisis center is available 24/7 for all LGBTQ youth who may need help or support.

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Suicide is preventable — and addressing the warning signs could help save a life.

If you or a loved one may be experiencing suicidal thoughts, connect with a mental health professional or crisis counselor for support.

The rollout of 988 is an opportunity to strengthen the nation’s crisis response system and expand access to care and support for individuals in the throes of a mental or behavioral health crisis — but only if call centers are ready.

“We need the federal government to increase public investment and break down barriers to physical and mental health care to give our communities the long-term care they so desperately need,” Mitchum said.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

While you wait for help to arrive, stay with them and remove any weapons or substances that can cause harm.

If you are not in the same household, stay on the phone with them until help arrives.

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