CONTENT WARNING, contains references to suicide and mental health crisis
If you or anyone you know is dealing with a mental health crisis, dial 988 immediately. There is hope.
The month of September is designated as Suicide Prevention Awareness Month. This month opens the door for behavioral health agencies and nonprofits to educate on the stigma of mental health and increase awareness of suicide. Nonprofits will host seminars, walks, and trainings throughout the month to increase awareness of suicide, and help professionals work with at-risk populations. These events are effective in bringing together survivors, impacted groups, and mental health professionals. In the larger context of these initiatives, the behavioral health community will also focus its efforts on increasing awareness of the 988 Lifeline. This blog will unpack 988 and how it will change the direction of suicide prevention efforts in Ohio.
From 2011 to 2020, Ohioans aged 20-24 accounted for 57% of all suicide deaths among youth (ages 10-24).
Who is most at risk?
Nationally, suicide is the tenth leading cause of death in America. In Ohio, suicide is the third leading cause of death for people aged 10-34. From 2011 to 2020, Ohioans aged 20-24 accounted for 57% of all suicide deaths among youth (ages 10-24). This period of time also saw an increase of suicide deaths among youth aged 20-24 at a rate of 39 percent with 2018 being the highest rate of suicide in the past decade.[1] Accounting for gender, suicide among Black non-Hispanic men and women have increased from 2019 to 2020 at a rate of 6% and 13% respectively. Suicide among white non-Hispanic men and women decreased 9% and 17% respectively. Hispanic men and women have had a steadily increasing suicide rate from 2016-2020, however, Hispanic men have had a decrease of deaths by 21% in 2020 while Hispanic women have had 29% increase of deaths from 2019-2020.
LGBTQ youth (ages 10-24) are also at a high risk of suicide. LGBTQ youth are four times more likely to die by suicide than their non-LGBTQ peers. A survey from the Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health reported that 45% of LGBTQ youth considered attempting suicide in the last year. Another group that is at extreme risk of suicide is veterans. From 2010-2019, veteran deaths by suicide were on average 2.59 times higher than suicide rates for Ohio adults. Across all age groups, veteran suicide was twice to three times higher than the average suicide rate of the same age group. In 2019, veterans aged 18-35 had an average suicide rate 3.7 times higher for all Ohio adults the same age.[2] Similarly, veterans aged 75+ had a suicide rate that was 2.67 times higher than the average suicide rate for adults in the same age group.
What is 988?
The National Suicide Hotline Act of 2020 required the Federal Communications Commission (FCC) to designate 988 as the general phone number for national suicide and mental health crisis support. 988 is a free[3] federal service number that provides 24/7 support for people who are in mental health distress or suicidal crisis. The three-digit code is beneficial in suicide prevention efforts because it is shorter, easier to remember, and connects services to vulnerable groups more quickly. 988 also reduces reliance on law enforcement and replaces larger healthcare spending (such as emergency room visits) with more affordable intervention services. The new number went into effect on July 16, 2022. The previous 10-digit number (1-800-273-8255) is still in use and can be utilized to reach the Lifeline as well.
How does 988 work?
There are two ways to connect with 988 support: call or text. If an individual texts 988, they will complete a survey informing a mental health counselor about their current situation. If the circumstances are extremely severe, the individual will be connected to a trained counselor at a crisis center in their nearby area. If an individual calls 988, they undergo a similar process of engagement. A crisis counselor will answer the call and begin the conversation by asking questions to understand the situation of the individual. Based on information provided, the counselor will then provide access to relevant services. Throughout the process, the Lifeline counselors will provide de-escalation and distress support. Calls are currently available in English or Spanish, with translation services available in over 250 languages. Texts are currently only available in English. Ohio’s Lifeline provider map provides local resources.
988 also provides support for veteran or active-duty service members.
988 also provides support for veteran or active-duty service members. In addition to veterans, the Lifeline also provides assistance to National Guard members, Reserve members, and friends/family who support them. To access the veteran Lifeline, callers press “1” after calling 988. From there, the caller will be connected to the Veterans Crisis Line. A crisis counselor will provide resources like free therapy, or local Veteran’s Affairs services. These local services also connect individuals to suicide prevention coordinators, outpatient clinics, vet centers,[4] veterans' benefits administration offices, and VA medical centers.
How is 988 Funded?
The Biden Administration has increased federal investment from $24 million to $432 million as a national priority for implementing the hotline.[5] Biden’s FY2022 budget request also allocated funding for the Lifeline and other federal crisis services. The rollout of 988 in individual states must be funded by state governments. Unfortunately, Ohio has not significantly contributed any major legislation to implement and fund the 988 hotline despite attempts to do so in the 2022-2023 State Budget. In the upcoming 2023-2024 State Budget, the state legislature, as well as the governor, should prioritize transforming mental healthcare which includes bolstering access to crisis services. By funding the lifeline, they can ensure that Ohio is prepared to handle the anticipated rise in outreach for years to come given that over the past 12 months, the National Suicide Prevention Hotline fielded 79,358 calls from Ohioans. Nationally, there are 11 states that have partial 988 implementation legislation enacted. These states include: Oregon, Utah, Kansas, Illinois, Indiana, West Virginia, Maryland, New York, Connecticut, Massachusetts, and New Jersey. Legislation ranges from servicing the Lifeline, developing training/protocols for non-law enforcement response, or bolstering children’s mental health services funding through a mental health omnibus bill authorizing fees for servicing the Lifeline, developing training/protocols for non-law enforcement response, or bolstering children’s mental health services funding through a mental health omnibus bill.
Ohio has not significantly contributed any major legislation to implement and fund the 988 hotline despite attempts to do so in the 2022-2023 State Budget.
Only four states (Washington, Nevada, Colorado, and Virginia) have passed comprehensive 988 legislation that allocates and implements funding for the Lifeline. Each of these states also have a tax associated with phone bills for the purposes of 988. Colorado has a fee of 30 cents, Virginia has a fee of 8-12 cents, Nevada has a fee of 35 cents, and Washington has a fee of 40 cents which will be enacted on January 1, 2023. Callers who need assistance in affording and paying for Lifeline services can get support at this link, with information on how to receive affordable communications services.
How does 988 differ from 911?
A very common question about 988 is about its differences with 911. It is important to highlight the distinction between the two services so that individuals in a crisis know what support is needed. Recovery Ohio created a helpful infographic that contains specific information on the difference between a mental health and/or addiction emergency or a mental health and/or addiction crisis:
My colleague, Natasha Takyi-Micah has also done extensive research on the overlap between 988 and maternal mental health, detailing services and programs allocated through the maternal mental health hotline.
The 988 Lifeline is an important addition in suicide prevention efforts across America.
Suicide Prevention Resources
The 988 Lifeline is an important addition in suicide prevention efforts across America. Suicidal ideation is something that can be treated, and there are available resources that can help. Listed below are some resources and services that are extremely valuable:
- Suicide and Depression Screening Tool
- Coping with Stress
- Ohio Suicide Prevention Foundation Resources Page
- Ohio American Foundation for Suicide Prevention
- S. Department of Veteran Affairs Suicide Prevention- Central Ohio
- The Trevor Project LGBTQ Suicide Prevention Counseling and Therapy[1] 10-Tony-Coder.pdf (mhsosw.org)
[2] Ohio Veteran Suicide Data Sheet (va.gov)
[3] In Ohio, there are no charges for using 988. Standard messaging and data rates still apply
[4] Refers to veterans who served in a combat zone or their family members
