Understanding Public Knowledge, Attitudes, and Intended Use of the 988 Lifeline

• In Event: Health Care Rights and Mental Health Policy in the United States

Abstract

Within the United States, roughly 40 million Americans identify as having a mental illness, with less than half of that population receiving treatment. Simultaneously, suicide rates in the United States have been steadily on the rise since at least 1999. As recently as 2019, suicide was the second leading cause of death for children and young adults, and the 10th leading cause of death in the United States overall. To address these concerning trends, Congress passed the National Suicide Hotline Designation Act in 2020. The act is designed to address mental health issues in the United States by rebranding the national suicide prevention lifeline as 988 – a 3-digit number akin to 911 for individuals to call in the case of a mental health emergency. In addition to the simplicity provided by a 3-digit number, the hope is that the new number – which went live on July 16, 2022 – will help more Americans access needed care. Many have also suggested that the line could help to ensure that individuals having mental health emergencies receive support from mental health experts instead of the police, potentially reducing violent interactions between the police and the mentally ill. Alternatively, some have urged those with mental illness not to call 988 – arguing that ‘988 is not friendly’ and that it could lead to involuntary treatment with troubling emotional and financial tolls. Surprisingly little is known about American attitudes towards this new lifeline, especially considering this split in messaging and the lifeline’s potential impact, with federal estimates suggest that it could receive somewhere between 13-41 million calls per year by 2027.

To address this lack of knowledge about an important new mental health policy, our research examines public attitudes about the 988 number in depth. Specifically, we rely on a demographically representative sample of 5,482 US adults conducted from June 24-28, 2022, on Lucid to examine public knowledge, public support, and intended use of the new 988 hotline. Our results show that just 3 weeks before the nationwide launch of the hotline, only 25% of Americans even knew about the new number, with Republicans, the elderly, and women least likely to know about its launch and those with high socioeconomic status most likely to be informed. Interestingly, we simultaneously found that only 73.45% of the public supported the creation of the new number, with Republicans and Blacks least supportive and the wealthy, those with poor mental health, and women more supportive of the program. When asked how likely they would be to use the 988 number if they or someone they knew was in need of mental health crisis services, 47.68% of the public said very likely, with an additional 29.71% indicating they would be somewhat likely to use the new number. Intended use was highest among those with poor mental health, higher incomes, higher religiosity, and the elderly and lowest among Republicans.

Combined, our results point to the need for additional intervention for the 988 number have a substantial impact in the United States. At a minimum, the fact that only a quarter of the American public knew about 988 just as the number was launched points to the need for additional efforts at promoting the new number. Equally important, targeted efforts are needed to promote the lifeline among Blacks and Republicans. Among Blacks, investigating whether highlighting reduced interactions with law enforcement when calling 988 is effective would be a useful next step. Among Republicans, who are less knowledgeable, less supportive, and less likely to use the platform, outreach from Republican leaders could prove helpful. Republican attitudes could also reflect growing politicization of public health more broadly and should be investigated for this possibility.

Authors

• Timothy Herbert Callaghan, Boston University

• Alva Ferdinand, Texas A&M University School of Public Health

• Aakriti Shrestha, Texas A&M University

• Alee Lockman, Texas A&M School of Public Health

• Kristin Kay Lunz Trujillo, Boston College

• Matt Motta, Boston University School of Public Health