Suicide prevention: New 988 hotline is the 911 for mental health emergencies

People considering suicide might show signs early on. Here's what to watch for

Friday, July 15, 2022
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Seven call centers around Illinois have been contracted to help individuals in crisis or their loved ones get help locally.

Quick help for suicidal thoughts and other mental health emergencies will soon be as easy as 9-8-8.

The United States' first nationwide three-digit mental health crisis hotline goes live on Saturday. It's designed to be as easy to remember and use as 911, but instead of a dispatcher sending police, firefighters or paramedics, 988 will connect callers with trained mental health counselors.

The federal government has provided over $280 million to help states create systems that will do much more, including mobile mental health crisis teams that can be sent to people's homes and emergency mental health centers, similar to urgent care clinics that treat physical aches and pains.

"This is one of the most exciting things that has happened" in mental health care, said Dr. Brian Hepburn, a psychiatrist who heads the National Association of State Mental Health Program Directors.

Hepburn cautions that when 988 kicks off, it will not be like "the flick of a switch. It's going to take a number of years in order for us to be able to reach everybody across the country."

Some states already have comprehensive mental health crisis systems, but others have a long way to go. And widespread shortages of mental health specialists are expected to slow their ability to expand services.

A RAND Corp. survey published last month found that fewer than half of state or regional public health officials were confident about being ready for 988, which is expected to generate an influx of calls.

Nearly 60% said call-center staffers had specialized suicide prevention training; half said they had mobile crisis response teams available 24/7 with licensed counselors; and fewer than one-third had urgent mental-health care units.

The 988 system will build on the National Suicide Prevention Lifeline, an existing network of over 200 crisis centers nationwide staffed by counselors who answer millions of calls each year - about 2.4 million in 2020. Calls to the old lifeline, 1-800-273-8255, will still go through even with 988 in place.

RELATED: FCC votes to make '988' the suicide hotline number

"If we can get 988 to work like 911 ... lives will be saved,'' said Health and Human Services Secretary Xavier Becerra.

Dispatching paramedics for heart attacks and police for crimes makes sense - but not for psychiatric emergencies, mental health advocates say. Calls to 911 for those crises often lead to violent law enforcement encounters and trips to jail or crowded emergency rooms where suicidal people can wait days for treatment.

The 988 system "is a real opportunity to do things right," said Hannah Wesolowski of the National Alliance on Mental Illness.

Sustained funding will be needed. According to the National Academy of State Health Policy, four states have enacted laws to impose telecommunications fees to support 988 and many others are working on the issue.

A desperate call to a Utah state senator in 2013 helped spark the idea of a three-digit mental health crisis line.

Sen. Daniel Thatcher says a good friend sought his help after taking his suicidal son to an emergency room, only to be told by a doctor to come back if the boy hurt himself.

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Thatcher has battled depression and at 17, he also considered suicide. He knew that despondent people in crisis may lack the wherewithal to seek out help or to remember the 10-digit national suicide lifeline number.

Thatcher found that many of Utah's in-state crisis lines went straight to police dispatchers or voicemail. He wondered why there was no 911 service for mental health, and the idea got national attention after he mentioned it to longtime Sen. Orrin Hatch.

In 2020, Congress passed the bill designating the 3-digit crisis number and then-President Donald Trump signed it into law.

Thatcher's mother was a nurse and knew where to get him help. He says 988 has the potential to make it that easy for others.

"If you get help, you live. It really is that simple,'' Thatcher said.

People considering suicide might show signs early on. Here's what to watch for

Suicide is a leading cause of death among children and adults, but spotting risk factors and warning signs isn't easy.

Nearly 46,000 people in the United States died by suicide in 2020, which is about one death every 11 minutes, according to the US Centers for Disease Control and Prevention. Worldwide, nearly 800,000 people die from suicide yearly, and in 2020, there were 1.2 million attempts globally.

Researchers still haven't nailed down how to better predict who's at risk for attempting suicide, and whether or when vulnerable people will do it, said Justin Baker, clinical director of The Suicide and Trauma Reduction Initiative for Veterans at The Ohio State University Wexner Medical Center.

"That is extremely, extremely difficult," he said. "You can look back in time, when someone's made an attempt or has died, and go, 'Oh, look at all these things that were going on in their life.' The difficulty is that a lot of people handle or experience those types of stressors as well but never go on to (attempt suicide)."

Additionally, there isn't always a long timeframe wherein someone is considering suicide and showing signs -- and there can be as little as 5 to 15 minutes between someone deciding to attempt suicide and doing it, Baker added.

"What we collectively understand is it's an emotional dysregulation and cognitive error that occurs," Baker said. "They can't fix the situation, or they can't think their way through the situation, so suicide becomes a viable option as a way to manage the pain that they're in. So they may take action on it in that really short, brief window."

But there are some situations wherein a person who is suicidal and planning for a longer period of time will show behavioral changes, Baker added.

"If you're noticing that kind of stuff, obviously that's someone who is really close to being imminent risk -- someone who's really close to making that decision to end their life," he said. "But I would argue most people don't get that kind of warning."

If you think you or someone you know is at risk, trained counselors with the 24/7 National Suicide Prevention Lifeline could help you work through any signs you're experiencing or seeing. To increase its accessibility, every state will roll out 988 as the new lifeline starting July 16. The current number is 1-800-273-8255 (TALK), and it will always remain available to people in emotional distress or suicidal crisis, according to the Substance Abuse and Mental Health Services Administration.

Here are some of the most common behavioral, verbal and emotional signs and risk factors you should pay attention to, according to experts.

Behaviors to watch for

Some people might seem like their usual selves in the weeks or days leading up to a suicide attempt, while others might show behavioral changes that don't track with what you know about them, said Michael Roeske, a clinical psychologist and senior director of the Newport Healthcare Center for Research & Innovation.

Those can include practicing or preparing for suicide, which could look like exhibiting unusual behaviors with guns, pills or other potentially lethal items, according to SAMHSA.

Other potential behavioral red flags include giving away cherished belongings, sleeping too much or too little, withdrawing or isolating oneself, showing rage or desire to enact revenge, and acting anxious or agitated, according to Roeske, Baker and SAMHSA. Getting really intoxicated one night or driving recklessly could also be signs to watch out for, Roeske said.

Such behavior might be them "testing themselves to see if they can actually do it," Baker said. "A lot of times people need to kind of work up to that actual making an attempt because it's a biologic thing you have to go against, your own survival."

Concerning comments

Talking about wanting to die -- by suicide or otherwise -- is another warning sign that should always be taken seriously, Roeske said. Such comments are sometimes just expressions of discomfort, pain, boredom or desire for closeness rather than a reflection of actually wanting to die, but that doesn't mean you don't monitor the person who's making them, he added.

Some people might say they feel like they have no reason to live. "If someone is struggling to come up with a reason for living, that's a much higher-risk person than someone who's even able to identify one (reason)," Baker said.

Others talk about feeling like a burden on those close to them, Roeske said, or like they don't belong anywhere or with anyone. Such comments might include "You don't need me for this anymore" or "I feel like it'd be better if I just wasn't here." Teenagers considering suicide might not want their guardians to use their money for college, he added.

Mood and other risk factors

Psychological factors, distressing situations or genetics can increase the likelihood of someone considering, attempting or dying by suicide, according to SAMHSA. These risk factors can't cause or predict a suicide attempt, but being aware of them is important, according to SAMHSA:

  • Hopelessness. "They don't have a sense of the future getting better, or they just feel really unable to imagine not being in the pain that they're in," Roeske said.
  • Extreme mood swings. This includes if someone who's usually really stressed or depressed suddenly seems calm or cheery, according to Roeske and Johns Hopkins Medicine. This person might have decided to attempt suicide without telling anyone, and they feel relieved by that. Also indicative of this is cheeriness after a depressive episode.
  • Obsession with death or lethal means. Some people have artistic or musical interests that are more grim than others, but if their engagement with those things surpasses what's normal for them, that would be concerning, Roeske said.
  • Experiences of abuse, neglect or other traumas
  • Substance abuse problems
  • Mental disorders such as schizophrenia, depression or anxiety, and personality disorders, especially coupled with lack of treatment
  • Severe physical illnesses, including chronic pain. "Especially if it's sort of recalcitrant and very difficult to treat, people can become very hopeless," Roeske said. "It's really just, 'I don't want to feel this anymore and I can't find any other way. I feel trapped.'"
  • Family or personal history of suicide. "The greatest predictor of completed suicide is past suicide attempts -- the reason being is because you'll see an escalation in lethality, or the means by which someone does it," Roeske said.
  • Job or financial loss
  • Relationship problems or loss
  • Loss of interest in activities or school
  • Prolonged stress from other causes, such as harassment or bullying
  • Easy access to potentially fatal means
  • Exposure to a suicide or to graphic or sensationalized accounts of suicide. "On the one hand, we don't want people to shy away from the topic of suicide. We want people to approach and even use the word with others and have discussions around it," Roeske said. But if a depiction or account gratuitously romanticizes or justifies the sense of relief that might be garnered from suicide, that's problematic.
  • Insufficient social support or sense of isolation
  • What to do

    If any of these signs resonate with you, seek professional help and talk with someone you can trust and feel supported by, Baker said. Psychotherapy and certain psychiatric medications, such as antidepressants, can help, Roeske said.

    If a loved one is showing signs they might be at risk of suicide, "it's not really your job to be able to predict the future," Baker said. But you can be supportive and intentional about asking them what's going on, Roeske and Baker said.

    "You're not going to cause someone to be suicidal by asking directly about suicide," Baker said. "The worst they're going to say is 'no' and not get offended. If they are, still ask them. I'd rather have someone offended at me than dead."

    When checking on someone, use what experts call a narrative, person-centered approach, Baker recommended. That might look like an open-ended question: "Hey, I've noticed life's gotten overwhelming these past couple days. Do you want to tell me about it?"

    As the person responds, you can, to some extent, listen, express appreciation for them sharing their story and offer to help figure it out together, without offering advice on how to handle it, Baker said. But if your loved one seems more at risk or in the process of attempting suicide, "you no longer have time or the luxury to get their opinion," he added. Get medical care or call 911.

    When Roeske first started working as a clinician, he had a young female patient who was a very accomplished equestrian, went to a prestigious school and had a lot of family resources, he said -- but she had been chronically suicidal for 10 to 15 years, since she was a teenager.

    "Every time she would go to her mom and tell her that, her mom would (say things like) 'Oh, you're so beautiful. Look at how you are with the horses,'" Roeske said. "And (the patient) said, 'What it felt like was Mom was afraid of what I was saying and needed to distance herself from it.'

    She said that therapists would do the same thing -- you know, 'create a positive gratitude list or correct your cognitive distortions.' Finally, there was a psychiatrist that looked at her as she said, 'I think I'm going to kill myself.' And the psychiatrist said, 'I think you might, too.' And she said it was the first time someone was willing to be in there with her."

    When talking with someone who's suicidal, you might want to tell them all the wonderful reasons why they should stay alive, Roeske said -- but that can actually make them feel more lonely.

    If you're concerned about someone who lives in your household, mitigate opportunities to attempt suicide by restricting access to or removing potentially lethal items such as firearms or pills, Roeske said. Just hiding a gun isn't a sufficient precaution, experts have said.

    Unfortunately, "we are no better able to predict who will die by suicide than who will be in a car accident," Baker said. "This does not help to alleviate the grief or pain for those who have lost loved ones to suicide, but hopefully it helps remove some of the guilt and responsibility."

    The Associated Press and CNN-Wire contributed to this post.