988: A new, simpler suicide lifeline number, with LGBTQ services to come

On July 16, Americans will be able to call or text a new phone number – 988 – if they feel they are experiencing a mental health crisis and/or are at risk of suicide.

The three-digit number will replace the 10-digit number for the National Suicide Prevention Lifeline, which can be reached by phone or text at 800-273-8255 and which also offers an online chat. The forthcoming switch to 988 is due to passage of the National Suicide Hotline Designation Act, which President Donald Trump signed into law in October 2020 after it passed the Senate with bipartisan support.

The legislation also mandated that the switch to 988 include a strategy to provide specialized services for LGBTQ youth, who are more than four times as likely to contemplate suicide than their non-LGBTQ peers, research shows.

Officials say they hope the new, shorter phone number will be easier for Americans to remember, with the goal of helping more people in crisis – and LGBTQ youth in particular.

But as the switch to 988 nears, officials have also said that more needs to be done to ensure that Lifeline providers can handle the expected increase in callers. NBC News reported last month, for example, that fewer than half the states have enacted legislation to pay for 988 implementation.

“We are at the start of a transition, not the end, and there is still a lot of work to be done,” said John Palmieri, acting director of the 988 and Behavioral Health Crisis Coordination Office at the Substance Abuse and Mental Health Services Administration (SAMHSA). The Lifeline, he added, has been “massively underfunded and under-resourced” since its 2005 inception.

Another major item on officials’ 988 to-do list: finalizing which LGBTQ-focused organizations will receive $7.2 million in earmarked funding to provide specialized services to LGBTQ youth who reach out to the Lifeline.

Experts who study the mental health of LGBTQ young people say it’s crucial that officials finalize plans and funding to ensure they can provide necessary LGBTQ-specific training to 988 crisis responders – especially given the torrent of legislation across the country targeting the rights of LGBTQ young people. They say LGBTQ-informed suicide prevention services can help offer crucial support in moments of crisis – and ultimately save lives.

“I do think this is something that they need to resolve quickly, because they are going to get phone calls from LGBTQ young people,” said Jessica Fish, an assistant professor of family science at the University of Maryland.

Fish added that given the onslaught of anti-LGBTQ legislation, the pandemic’s effects on mental health and the existing data showcasing disparities in depression and suicidality, the Lifeline needs “to be prepared to funnel those folks to providers on the phone who can navigate that in a way that is sensitive, knowledgeable, empathetic and aware of the unique experiences of LGBTQ youth in particular.”

Conversations between Lifeline officials and potential LGBTQ-youth-focused 988 providers are ongoing, according to a SAMHSA official and John Draper, Lifeline’s executive director and executive vice president of national networks for Vibrant Emotional Health, the New York City-based mental health service provider tasked with administering 988.

Draper added that “all counselors will receive trainings from experts in providing affirming services to LGBTQIA+ individuals in crisis.”

One survey conducted by the Centers for Disease Control and Prevention between January and June of 2021 found that nearly half of gay, lesbian and bisexual teens said they had contemplated suicide during the pandemic, compared with 14% of their heterosexual peers.

The Trevor Project, which focuses on suicide prevention for LGBTQ youth, said in a report: “LGBTQ youth are not inherently prone to suicide risk because of their sexual orientation or gender identity but rather placed at higher risk because of how they are mistreated and stigmatized in society.”

Some of that mistreatment and stigma, experts say, comes in the form of policy, including a Florida law – which critics have dubbed “don’t say gay” – that took effect Friday and bans teachers in kindergarten through third grade from discussing gender and sexual orientation in class.

And the Supreme Court’s recent overturning of Roe v. Wade and Justice Clarence Thomas’s concurring opinion that called for the high court to reconsider its decisions in the cases that legalized same-sex marriage and invalidated anti-sodomy laws also are likely to have negative impacts on the mental health of LGBTQ young people, according to Jeremy Goldbach, a professor of sexual health and education at Washington University in St. Louis.

“It creates anxiety,” Goldbach said of these current events. “You don’t have to actually even be the direct victim of a law to have it affect you.”

In addition to anti-LGBTQ laws, stigma can manifest through discourse shaped by politicians, media coverage and dinner table conversations, according to Fish. That makes it all the more crucial that 988 counselors are trained to respond to the needs of young LGBTQ people in crisis, she added.

“I think this crisis line could – if folks are trained to work with this community – offer enormous benefit to LGBTQ young people who may or may not feel like they can go anywhere else,” Fish said. “But it could also then create additional harms if folks are not ready and prepared or trained to work with this community.”

A report published last month by the Rand Corp., an independent research organization, found that only 45% of the public health officials tasked with helping roll out the new Lifeline said their staff had training to interact with LGBTQ people.

Draper said that Vibrant has provided 988 crisis responders with “multiple educational webinars and guidance documents” focusing on inclusive language and best practices on how to support LGBTQ youth who contact 988.

He declined to discuss which LGBTQ-focused organizations are being considered as 988 providers, but noted that “the Trevor Project has long been a collaborator and valuable adviser to Vibrant in support of the Lifeline’s service to LGBTQIA+ populations.”

The Trevor Project operates a 24/7 crisis hotline that serves more than 300,000 LGBTQ youth a year through calls, texts and online chats managed by more than 2,000 trained volunteer crisis counselors from across the country, according to a spokesperson.

Preston Mitchum, director of advocacy and government affairs for the Trevor Project, confirmed that the organization’s officials have been in conversation with Vibrant and SAMHSA officials about potentially providing specialized services for LGBTQ young people through 988. He added that Trevor Project officials hope to be able to actually start providing services to LGBTQ youth who reach out to 988 by September if the organization winds up finalized as a subcontractor.

“It’s not just about getting the funding, it’s about [the] timing allowed for implementation to occur once the funding is ultimately received,” Mitchum said. “I want to be clear that the goal in providing the best care and service delivery for people should not be rushed.”

Research suggests that the Lifeline’s crisis counselors could also play a significant role in the lives of LGTBQ young people who reach out to them. The Trevor Project’s 2019 national survey found that LGBTQ youth who reported having at least one accepting adult were 40% less likely to report a suicide attempt in the past year than those who didn’t, even while controlling for race/ethnicity, age and gender identity.

Goldbach said that LGBTQ-informed crisis counselors are particularly crucial for LGBTQ young people in crisis given that they’re often “not surrounded by other LGBTQ people who can … help them make meaning” out of their identities and experiences of discrimination.

LGBTQ-informed 988 crisis counselors should also ask for young peoples’ pronouns and avoid making assumptions about their gender identities based on the sounds of their voices, Goldbach and Fish said. (The Lifeline’s online chat currently allows people to specify their gender identity but not their pronouns.)

Another approach that crisis counselors should keep in mind, Goldbach said, is to listen to what extent, if any, LGBTQ young people talk about their gender identity and/or sexual orientation having a role in their mental health crisis.

“There are times when young queer people have a crisis that isn’t necessarily wrapped up in identity” – such as going through the pain of a breakup – “and I think sometimes people who don’t have a lot of experience in counseling with queer people keep wanting to take it back to that and assume that that must be the core of the problem, and that can be really stigmatizing,” he said.

Other aspects of identity – including socioeconomic status, racial and ethnic identities, immigration status and age – can also shape the particularities of LGBTQ youths’ experiences, Goldbach added, making it important to take them into consideration.

“I think, in the end, there’s a lot of different things that come forward in any given moment and that crisis is not always about the same thing,” he said.

Of the ongoing discussions about how exactly specialized LGBTQ services will be provided through 988, Mitchum said Trevor Project officials are “going to be there every step of the way to make sure we reach the finish line.”

In the meantime, Goldbach urged crisis counselors across the country to make use of the Trevor Project’s online resources and seek out local LGBTQ centers to potentially learn more about how they can best serve LGBTQ youth.

“If we all just wait for the government to step in and provide the training, I think we might be waiting a little while,” he said. “There are resources, especially in LGBTQ centers, [that] are great places to start if you want local training.”

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