New Data Expose Critical Care Gaps in 988 Crisis Lifeline

Even with more than 16 million instances of contact since it launched across the US in July 2022, with almost half of these contacts (8,050,380; 49.3%) coming in 2024 alone, lifetime use of the 988 suicide and crisis lifeline came in at less-than-expected levels for the year ending December 2024.

Overall, the 988 contact incidence rate per 1000 population was 23.7 for 2024 compared with 48.9 over the lifeline’s lifetime, with corresponding repeat contact rates of 2.4% and 1.6%, according to new research published online today in JAMA Network Open.1 This cross-sectional study comprised an investigation of state, national, and regional data on all routed calls, texts, and chats—the lifeline’s 3 contact methods—from the launch through December 2024, including initial contacts that were subsequently rerouted to the Veterans Crisis Line, the LGBTQ+ Line, the Native Line, or the national backup center.

Highlighting the lack of research on the lifeline, with just 3 major studies conducted that underscored a lack of awareness of the 988 lifeline2,3 and funding that was insufficient in more than half of all states,4 the present authors obtained their data from Vibrant Emotional Health, an advocacy organization for emotional well-being that also is in charge of running the lifeline.5

The authors made sure to note that demographic information about any 988 contact or repeat contact is not available. For first contacts, they calculated lifetime and past-year incidence rates, estimated lifetime and past-year 988 use, and adjusted prevalence estimates to “reflect assumptions about repeat contacts.”

For the study period, the most total (lifetime) contacts were 5,363,263 from the South region, followed by 4,445,070 from the West; 3,508,011 from the Midwest; and 3,017,363 from the Northeast. Within the past year, however, although the most contacts still came from the South (2,643,223), the West moved up to the #2 position (2,167,638); contacts from the Midwest kept that region in the #3 spot (1,681,945) and the Northeast again had the fewest (1,557,574).

Those in crisis can contact the 988 suicide and crisis lifeline by calling, texting, or chatting online; more than 16 millions contacts have been initiated since since the nationwide lifeline launched in July 2022. | Image Credit: 7N23-stock.adobe.com

“We adjusted the lifetime prevalence estimate to reflect the assumption that every person who contacted 988 used it a mean of 2.0 times,” the authors wrote, “and adjusted the past-year prevalence estimate to reflect the assumption that every person who contacted 988 used it a mean of 1.5 times.” They also used 2023 population data for lifetime estimates and 2024 population data for past-year contact rates, because national implementation of place-based 988 georouting was only implemented in November 2024, they explained.

When contact incidence rate per 1000 population was calculated, the West region had the most contacts, at 56.3, followed by the Northeast, Midwest, and South with 53.0, 50.9, and 41.4, respectively. The corresponding rates for 2024 alone were 27.1, 26.9, 24.2, and 20.0.

The authors’ analysis to gauge repeat contact–adjusted 998 use produced regional results that did not vary from how the regions were positioned for the rate per 1000. The West had both the highest lifetime (2.8%) and past-year prevalence (1.8%) rates, and the Northeast was not far behind (2.6% and 1.8%, respectively). The Midwest had the third highest prevalence rates (2.5% and 1.6%), with the South having the lowest (2.1% and 1.3%).

At the state level, Alaska with 45.3 and Vermont with 40.2 had the highest past-year contact incidence rates, and Delaware with 12.5 and Alabama with 14.4 had the lowest past-year contact incidence rates.

The authors expressed disappointment in the results they saw, in particular that the past-year 988 contact rate was so low at less than half of the equivalent rate for adult emergency department visits with a resulting mental health diagnosis (23.7 vs 53.0). They also noted that the heterogeneous state and regional results correlate with levels of funding and legislation directed toward the 988 lifeline, “both of which may affect awareness and use.”4,6

They speculated that political leanings may influence statewide attitudes toward the lifeline, with the conservative views of the South linked to less favorable views of the 988 lifeline and its lower rate of use in that region—a finding seen in previous research.7

Indeed, the Trump administration has a proposal in the works, leaked in late April, that would pull funding for the specialists tasked with heading up the LGBTQ+ line for 988, despite President Donald J. Trump using legislative action to initially establish the lifeline in October 2020.8 Individuals who identify as LGBTQ+ have a higher risk of suicide and are more likely to report discrimination, face social stigma, and encounter barriers to care.

References

1. Purtle J, Mauri AI, Bandara S, Stuart EA. Use of the 988 suicide and crisis lifeline at national, regional, and state levels. JAMA Netw Open. 2025;8(6):e2514323. doi:10.1001/jamanetworkopen.2025.14323
2. Poll of public perspectives on 988 & crisis response (2024). National Alliance on Mental Illness. Accessed June 9, 2025. https://www.nami.org/support-education/publications-reports/survey-reports/poll-of-public-perspectives-on-988-crisis-response-2024/
3. Purtle J, McSorley AMM, Adera AL, Lindsey MA. Use, potential use, and awareness of the 988 suicide and crisis lifeline by level of psychological distress. JAMA Netw Open. 2023;6(10):e2341383. doi:10.1001/jamanetworkopen.2023.41383
4. Purtle J, Ortego JC, Bandara S, Goldstein A, Pantalone J, Goldman ML. Implementation of the 988 suicide & crisis lifeline: estimating state-level increases in call demand costs and financing. J Ment Health Policy Econ. 2023;26(2):85-95.
5. What we do. V!brant Emotional Health. Accessed June 9, 2025. https://www.vibrant.org/what-we-do/
6. Purtle J, Soltero M, Crane ME, McSorley AMM, Knapp M, Drapeau CW. State legislator social media posts about the 988 suicide and crisis lifeline. JAMA Netw Open. 2023;6(10):e2339845. doi:10.1001/jamanetworkopen.2023.39845
7. Callaghan T, Ferdinand AO, Motta M, Lockman A, Shrestha A, Trujillo KL. Public attitudes, inequities, and polarization in the launch of the 988 lifeline. J Health Polit Policy Law. 2024;49(3):473-493. doi:10.1215/ 03616878-11066312
8. Bonavitacola J. Cutting specialists from suicide hotline threatens LGBTQ+ youth, experts say. AJMC®. May 5, 2025. Accessed June 9, 2025. https://www.ajmc.com/view/cutting-specialists-from-suicide-hotline-threatens-lgbtq-youth-experts-say