Mental health in the US has become a growing population and public health concern in recent years, and the COVID-19 pandemic served to exacerbate these concerns further. During the pandemic, patient demand for mental healthcare surged, but access barriers persisted for many patients seeking care.

The federally mandated 988 hotline is one attempt to improve the American behavioral and mental health crisis care system, designed to transform the system as 911 did for emergency medical services. The three-digit number was officially launched in July as an easier-to-remember alternative to the National Suicide Prevention Lifeline.

Individuals can call, text, or chat 988 during a behavioral or mental health crisis to be routed to the nearest local crisis center to receive help, including crisis counseling, resources, referrals, or mobile crisis unit dispatch. However, concerns about crisis center capacity and hotline usage, which is expected to triple within the first year.

The primary goal of the number is to make it easier for people to call for help. Lawmakers and mental health advocates also see this service as an opportunity to transform the mental health care system and make care easily accessible everywhere in the United States.

Currently, the majority of people experiencing a mental health emergency end up dialing 911. The problem is that 911 wasn’t set up to address mental health needs. Either caller ends up in a frenetic emergency room, waiting for hours and sometimes days to get care, or they end up interacting with law enforcement, which can lead to tragedy or trauma.

Mental health advocates hope that 988 will become a widely known, safer, and more effective alternative. People who call or text the number will be connected to a trained counselor at a crisis center closest to them. If a local crisis center is too busy to respond right away, the call gets routed to one of 16 backup centers around the country.

For the vast majority of people who call the lifeline, the call itself is an effective intervention. “We know that close to 90% of people who call get what they need from the phone call,” says Chuck Ingoglia, CEO of the National Council for Mental Wellbeing.

The remaining 10% of callers may need additional support or in-person care, and trained counselors at the lifeline will try to connect them to that care.

According to 988’s website, the long-term vision includes “a robust crisis cares response system across the country that links callers to community-based providers” like BlackLine or Trans Lifeline, a crisis hotline operated by and for transgender and nonbinary people. Trans Lifeline’s former executive director sat on the Individuals and Families with Lived Experiences Committee.

“I have so much respect for the people that are working to create a system for support, and I do think that 988 is a really great opportunity to expand the resources available to people in need,” Trans Lifeline Director of Advocacy Yana Calou said. “If 988 would route to … alternative, community-based supports like ours, that would really go a long way to making sure that people get to speak with the person that they need.”

In some cases, if a caller first contacts 911, those dispatchers can dial a direct line to quickly reach the nearest crisis center. Goodwill of the Finger Lakes in Rochester, New York, maintains that relationship with 911 operators, said Deborah Turner, the organization’s Lifeline program director. Her staff contacts 911 as “an absolute last resort” and requires operators to get a supervisor’s approval before getting emergency teams involved.

One side is going well to take phone calls but the other side is still having difficulty. Ever since its launch in 2005, the existing 10-digit lifeline has seen increasing use but until recently, local call centers received very little federal funding.

“They’ve been operating on a shoestring for many, many years,” says John Draper, the executive director of the National Suicide Prevention Lifeline. Many centers have closed because of a lack of resources in recent years.

According to the Department of Health and Human Services (HHC), in 2021 the lifeline received 3.6 million calls, chats, and texts. But a 2021 report by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that the current system is able to respond to only 85% of calls, 56% of texts, and 30% of chats.

The Biden administration has dedicated $432 million — up from $24 million — toward building the capacity of local and backup call centers and providing associated services, including a subnetwork for Spanish speakers, according to a statement from the HHS.

And that’s significant, says Draper. “A number of centers are [now] being funded in ways that they’ve never received funds before, so it’s very encouraging,” he says.

The centers have been able to hire new staff, and the lifeline has been able to expand the capacity of backup centers.

The future of mental health response includes expanded financial support for community-based mental health teams and mobile crisis response groups, the 988 site says. In the meantime, smaller organizations including BlackLine and Trans Lifeline plan to continue helping their communities and plan to grow with hopes of receiving more funding.

“I really see so much potential and opportunity (in 988),” said Calou. “I just really want people to know what they’re getting when they call and want us to think about whom we can find to do this work.”