Only 13% of adults in the U.S. have heard of the 988 Suicide and Crisis Lifeline and know its purpose nine months after its launch, according to a nationally representative survey conducted for The Pew Charitable Trusts.
In July 2022, the U.S. launched 988, a service established by Congress to connect with a trained counselor the growing number of people experiencing mental health or substance use crises. The effectiveness of a standard number, such as the emergency 911 number or 988, relies on people being aware both of its existence and of when to call. The survey, conducted for Pew by Ipsos Public Affairs in April 2023, can serve as a baseline as outreach efforts expand to match growing service capacity and need.
While many said they would use 988, concerns remain
Pew asked people whether they had heard of the new 988 service; those who responded yes were asked when someone should use it. Awareness of 988 was measured as answering yes to having heard of the service as well as providing an answer for when to contact 988 besides “don’t know” or “not sure.” Although 18% said they had heard of 988, over a fourth of these individuals (26%) indicated they didn’t know or weren’t sure when someone should contact it. This translated into about 13% of people who had the knowledge of both 988’s existence and purpose.
When informed of what 988 was for (“988 is the 3-digit Suicide & Crisis Lifeline that people can contact if they or someone they know is experiencing a suicidal, substance use, and/or mental health crisis or is in emotional distress. 988 offers 24/7 call, text and chat access to trained crisis counselors”), about 7 in 10 people said they were somewhat likely or highly likely to use it, indicating an opportunity for the service to have a significant impact. Possibly dampening this impact, though, are concerns people have about potential negative consequences of calling: About 2 in 5 expressed concern that calling 988 might result in law enforcement being sent, being forced to go to the hospital, being charged for services they couldn’t afford to pay, or other people finding out they’d called.
People with greater awareness of 988 identified as White, had a higher income, or had greater educational attainment
Although awareness of 988 and its purpose was low across all racial and ethnic groups, twice as many White, non-Hispanic people had heard of 988 and knew its use compared with their Black, non-Hispanic counterparts, with Hispanic individuals similarly having lower awareness. (The Ipsos survey did not report on other races.) Other notable disparities: Those with a college education (compared with those with a high school degree or less) and those making over $50,000 a year had greater awareness of 988.
Awareness of 988 is somewhat higher among those who could be considered a target audience. People who said they had been diagnosed with or believe themselves to have a mental health issue were more likely (22%) to be aware of and know the reason for 988 than respondents overall.
While still only at 20%, 988 awareness for people who identified themselves as lesbian, gay, bisexual, transgender, or another identity other than straight/heterosexual (LGBT+) was also higher than for people who identified as straight/heterosexual. About 40% of LGBT+ individuals indicated they had a mental health issue, compared with 15% of people identifying as straight/heterosexual; these higher numbers are consistent with those from the Centers for Disease Control and Prevention’s surveys administered by the U.S. Census Bureau during the pandemic, and a recent survey of LGBT+ young people. The U.S. Substance Use and Mental Health Administration is piloting a specialized 988 service for LGBT+ young people to address their higher risk of suicide.
988 usage and concerns that might affect willingness to use the service
The extent to which people contact 988 may depend on their perceptions of whether negative consequences might result. Roughly 2 in 5 of all respondents, after being provided the language describing 988 and its purpose, said they had concerns that if they used it, law enforcement might be sent, they’d be forced to go to the hospital, they’d be charged for services when they couldn’t pay, or others might find out. About 1 in 4 people worried they’d end up in jail.
People with mental health issues, however, were more concerned than those without mental health issues that law enforcement would be sent (56% versus 40%), they would be forced to go to the hospital (55% versus 38%), they’d incur costs they couldn’t pay (49% versus 35%), and that others would find out (46% versus 36%). LGBT+ individuals were more likely than those identifying as straight to be concerned that police would be sent (55% versus 40%), they would be forced to go to the hospital (50% versus 39%), they’d end up in jail (30% versus 23%), they would be charged for services they couldn’t pay for (45% versus 36%), and that 988 responders wouldn’t be able to handle the issue they called about (42% versus 33%).
Addressing these concerns might well boost use of 988. Although only 1% of people who’d heard of 988 said they or someone they know had used 988, about 7 in 10 of all respondents, after being provided information on the 988 system’s purpose, said they were somewhat or highly likely to use it if they or someone they knew was suicidal or having a mental health or substance use crisis.
Looking ahead
988’s predecessor, the Suicide Lifeline (1-800-273-TALK), reported about 4 million routed call, chat, and text contacts a year. While 988 is not likely to meet the ambitious goals set out prior to its implementation, based on reported monthly contacts, the new crisis line is on track to increase the number of contacts in its first year to about 5 million.
This survey provides useful benchmarks to help gauge awareness of 988 moving forward. Additional outreach at all levels is necessary, with specialized plans and messages to reach some of those showing somewhat lower levels of knowledge about 988. Also, national, state, and local messages should use messengers and platforms trusted by various communities to provide accurate information about what happens when someone contacts 988, so that when the time comes, people aren’t afraid to pick up the phone to call, text, or chat. Given the growing mental health crisis in the U.S., expanding equitable use of this valuable resource will contribute toward a stronger continuum of crisis care and, ultimately, save lives.
