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Survey Shows Who’s Using 988—and Raises Questions About Why More People Aren't
Introduced almost 18 months ago, the 988 Suicide and Crisis Lifeline has ushered in a new era with the potential for major transformation in how behavioral healthcare is approached and delivered. In its initial month of operation, July 2022, the lifeline responded to about 354,000 calls. By contrast, in September 2023, it responded to 439,000 calls, an increase of more than 24%.
As it develops, it is important that we know more about those who are using the lifeline and how they are responding. That is why a study published recently in JAMA Network is of great interest. Researchers Jonathan Purtle, Anna-Michelle Marie McSorley, Abigail Lin Adera, and Michael A, Lindsey developed a nationally representative, cross-sectional, web-based survey of 5058 US adults (response rate of 55%), conducted during June 2023. Results were weighted to represent the US population.
Participants completed the Kessler K6 Scale to assess the degree of their psychological distress and were placed into one of the following categories: serious, moderate, or no psychological distress. They then we asked whether they had heard of the lifeline, had used it, and whether they would in the future.
Overall, the percentages of the population by level of psychological distress are generally reflective of results from other national epidemiological surveys. A total of 7.9% of respondents experienced serious psychological distress; 20.4%, moderate distress; and 71.8, no distress.
Principal findings from the study include the following:
- About 47.4% of those with serious psychological distress had heard of the lifeline, compared to only 40.4% of those with no distress.
- Only 6% of those with serious psychological distress had used the lifeline, compared with 0.2% of those with no distress.
- Only 22.3% of those with serious psychological distress would be very likely to use the lifeline in the future, compared to 26.2% of those with no distress.
What are some of the implications of these findings?
Much more work needs to be done to acquaint US adults that the 988 lifeline actually is available for their use. Results from the present research suggest that about 60% of the population does not know this fundamental fact. Findings also suggest that those who are older, have less income and/or education, and who are minorities are less likely to know about the lifeline. Thus, new approaches may be required to inform these different groups about this important resource. The Substance Abuse and Mental Health Services Administration (SAMHSA) is currently undertaking initiatives to improve awareness of 988.
We also need to understand why only 6% of those with serious psychological distress used the lifeline, when 47.4% of this group had heard about it. This is a use rate of only slightly above 12%. Did this group use other resources—a local helpline, other local support, a peer, or other friend, etc.? Were they reluctant to use the lifeline for some reason? Did they have difficulty in accessing or using the lifeline?
Finally, we need to learn why only 22.3% of those with serious psychological distress would be very likely to use the lifeline in the future. This reflects a potential future use rate of about 47% for those who were knowledgeable about the system. We need to understand more about those who did not choose this option, and why the potential future use rate for those with no distress, about 65%, is higher than that for those with serious psychological distress.
Some questions: Do some with serious psychological distress have fears about using the lifeline? Do they feel that it will not be helpful? Do they have alternate resources that they can rely upon—peers, family members, other care providers?
This research has provided very valuable information about the 988 lifeline and its users. More research of this type should be undertaken very soon. Clearly, we have many additional questions about those who have used or may use the system in the future. We need answers to these questions if we are to undertake programs to increase knowledge about 988 in the community, and to expand its accessibility to those with serious psychological distress. This work likely will require interviews and focus groups to be conducted with community members.
Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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