Dr. John Palmieri, Richard McKeon, James Wright, and the 988 and Behavioral Health Crisis Coordinating Office

Suicide is a leading cause of death in the United States, especially among adolescents and people ages 25 to 34, while mental health crises along with drug overdoses have been escalating dramatically. 

To help people in suicidal crisis and emotional distress, a team from the Substance Abuse and Mental Health Services Administration led by Dr. John Palmieri, Richard McKeon and James Wright implemented a new and simplified nationwide three-digit voice and text hotline in 2022 called 988, providing trained counselors 24/7 for suicide, mental health and drug crises. 

This 988 Lifeline replaced the 10-digit national suicide telephone line, expanded the number of available trained counselors, set up call centers in states through significantly enhanced federal funding and continued to link to the Veterans Crisis Line. 

Since its launch, the new service has reduced wait times from over three minutes to an average of 40 seconds and assisted greater numbers of people compared to the old 1-800 number. In January 2023, for example, the service handled about 450,000 calls, texts or chats, almost double the number from a year earlier when the 1-800 number was in use. 

“The work of the 988 team has led to enhanced response rates and improvements in average speed to answer, expanded crisis assistance to individuals with substance use conditions and developed core training for counselors,” said Thomas Coderre, SAMHSA’s principal deputy assistant secretary.  

The text messaging option has benefited the younger generation  

In the past, people suffering from depression or considering suicide could dial the 1-800 number or chat and talk to a counselor if they could get through. Despite the best efforts of behavioral health care professionals and crisis-prevention volunteers, technology issues, staffing shortages, funding and language barriers sometimes made it hard for individuals to reach a crisis center counselor when time mattered. 

That changed dramatically with the launch in 2022 of the 988 number. With the new, easier-to-remember three-digit number and the significant investments in staffing the system, the ability to get help right away with a call, text message or online chat grew exponentially along with the number of people who were helped compared to the older 1-800 number. As a result, hundreds of suicidal people who were previously unable to access help are now being responded to every day. 

Callers using the new text messaging system, a critical method of communication for younger people, were among those greatly benefiting from the new system.  

Palmieri, a senior medical adviser, was responsible for leading the 988 office’s coordinated strategy, overseeing the 988 rollout and planning for enhanced service nationwide.  

Wright managed the cooperative agreements with state leaders and the private-sector network administrator, strengthened the infrastructure, upgraded the Spanish language capabilities used by the old 1-800 number, oversaw the expansion for LGBTQ+ youth services and helped the states shore up over 200 local call centers with additional staffing.  

McKeon, a senior advisor, is one of the country’s preeminent experts on suicide, originally creating the Lifeline network in 2005 and overseeing the initial work transitioning to the three-digit number.  

Public trust was at stake 

“This team focused on the mission, and they also care about people who suffer and understood what this project would mean to the public trust,” said Andrea Palm, deputy secretary of the Department of Health and Human Services. “There were many potential fail points, but they didn’t allow it to fall apart. It was quite an accomplishment.” 

The original National Suicide Prevention Lifeline had been in place since 2005, but staffing ranged from professional call centers and lines designated for veterans to phones answered by volunteers in church basements. Some states had gaps in their ability to manage calls, while language barriers in Spanish-speaking regions posed another problem.  

Congress approved the creation of the new three-digit hotline in October 2020, and the SAMHSA team worked with the Federal Communications Commission, the Department of Veterans Affairs and other agencies to make it a reality. 

“Our agency is dedicated to improving the well-being and mental health of America,” said Palmieri. “The 988 hotline is an inflection point and an opportunity to change the way people receive important crisis services.”