Key Takeaways

  • While older adults only make up 12% of the U.S. population, they account for 18% of all suicide deaths.

  • The 988 Suicide and Crisis Lifeline aims to expand crisis care access to older adults and other populations in need.

  • 988 (phone or text) is free, confidential, and available to everyone in the U.S. 24 hours a day, 7 days a week.

Suicide is the 12th leading cause of death in America, claiming the lives of 45,979 people in 2020 alone.1 While older adults only make up 12% of the U.S. population, they account for 18% of all suicide deaths.2 Other groups with higher-than-average suicide rates include veterans, people in certain occupations (e.g., mining), and those who live in rural areas.

Despite these jarring numbers, suicide is not an inevitable outcome for anyone. By providing immediate and direct aid to people in their most desperate hour, we can help them overcome their struggles, find hope, and heal. This is the goal of the 988 Suicide and Crisis Lifeline.

What is 988 and how can it help older adults?

988 is part of the Biden administration's commitment to addressing the national mental health crisis. It involves transitioning the National Suicide Prevention Lifeline phone number from its current 10-digit form to a three-digit, easy-to-remember dialing and texting code.

Through skilled, person-centered support, the Suicide Prevention Lifeline currently helps thousands of Americans move past crisis situations each day. This service is available to anyone experiencing a mental health-related emergency, whether it’s severe emotional distress, a substance use crisis, or thoughts of suicide or self-harm. People can also dial 988 if they’re worried about the safety and well-being of someone else. Users of 988 can reside in any U.S. state but must have access to telephone, cellular, or internet services.

988 is part of a bolder, longer-term vision of a robust and nationwide crisis care infrastructure. Funding for its implementation is being provided by the Biden administration’s Fiscal Year 2022 budget, funds from the American Rescue Plan, and various grants. The initial $282 million investment will help bolster existing Lifeline network operations and telephone infrastructure and strengthen the workforce across local call centers.

"The new 988 number is an important start in helping us build out our mental health and substance use services for older adults," says Deb Steinberg, a health policy attorney at the Legal Action Center (LAC). "Suicide and overdoses are rising among older adults, but they are often preventable with appropriate resources and treatment.”

What happens when someone calls 988?

People who call or send a text message to 988 are put in touch with a trained counselor who lends a compassionate listening ear, without bias or judgement. Lifeline counselors are largely volunteers. They are experienced in talking to people about a range of issues, from economic worries and physical illness to relationships and abuse. Counselors not only provide immediate emotional support; they often refer callers to services and resources that can deliver ongoing mental health care. Studies have shown that after talking to a Lifeline counselor, people often feel less depressed and more hopeful about their situation. It’s important to note that law enforcement may be called in if a distressed caller is determined to be in immediate danger.

Operating from more than 200 call centers nationwide, the Lifeline is available 24 hours a day, 7 days a week. In addition to phone and text, callers can talk to a counselor via live chat by visiting the Suicide Prevention Lifeline website.

Will 988 and 911 work together?

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) is working with state and local agencies to create seamless coordination between the 988 and 911 systems. This will facilitate referrals of high-risk callers in crisis who may need additional interventions.

Does 988 serve veterans in emotional crisis, too?

Yes. The existing Veterans Crisis Line, which has counselors who specialize in supporting veterans, service members, and their families, will still be available. Callers should dial 988 and then press "1" to reach the Veterans Crisis Line or dial 1-800-273-8255 and press "1." If texting is preferred, they can text 838255 to reach the Veterans Crisis Line directly. Callers do not have to be receiving VA benefits or health care to call the crisis line.

How will 988 address equity and diversity?

Providing equitable access to crisis care is at the core of 988. While Lifeline text and chat are currently offered in English only, its voice call services are offered in English and Spanish (translation services are also available). Efforts to improve cultural competency training for Lifeline counselors are ongoing. These include providing them with tools to improve their interaction with LGBTQ+, Spanish-language, and deaf and hard of hearing populations.

In addition, as part of funding requirements, states and territories are mandated to:

  • Examine strategies for reaching groups with an elevated risk of suicide, many of whom are historically marginalized.
  • Develop plans to measure their success in improving access to services across different populations.
  • Coordinate with tribal nations to ensure appropriate support for tribal calls to 988 while still recognizing tribal nation sovereignty.

The need for a more comprehensive approach to suicide prevention

The grief, fear, and isolation of the COVID-19 pandemic have amplified America’s struggles with mental health. During 2020, 1 in 5 adults experienced mental illness. Many people also reported increased use of alcohol and other substances to deal with stress.3 These issues highlight the need to not only to expand access to mental health services, but also access to crisis response for people in acute psychological distress.

With America’s mental illness burden growing, stronger suicide prevention efforts can’t wait. Beyond the tragic loss of a life, suicide can have a devastating and enduring impact on families and communities. Surviving family members and friends may struggle with overwhelming grief, guilt, depression, and anxiety. Even when a suicide attempt is unsuccessful, a person may experience long-term mental and physical health effects. Suicide and self-harm also exact a grueling financial toll: in 2019, these issues cost the U.S. nearly $490 billion in medical costs, employment-loss costs, and more.4

The positive news is that with a comprehensive and well-coordinated public health approach, we can save lives while shaping emotionally healthy and resilient individuals, families, and communities. A powerful starting point is implementing—and widely promoting—the 988 Suicide and Crisis Lifeline.

“As we continue to confront the impact of the pandemic, investing in this critical tool is key to protecting the health and well-being of countless Americans—and saving lives,” explained Department of Health and Human Services (HHS) Secretary Xavier Becerra in a press release. “Giving the states a tool to prevent suicide and support people in crisis is essential to our HHS mission of protecting the health and well-being of everyone in our nation.”

To learn more about 988 and suicide in older adults:

  • Visit the SAMHSA website.
  • Explore the 988 Partner Toolkit, which provides a wealth of resources that can be implemented in local suicide prevention efforts.
  • Watch the replay of “Understanding and Preventing Suicide in Older Adults,” a live session held during NCOA’s 2022 Older Adult Mental Health Awareness Day Symposium.

Note: The old Lifeline phone number (1-800-273-8255) will continue to be available to people in emotional distress, even with the national launch of 988.

Sources

1. American Foundation for Suicide Prevention. Suicide statistics. Found on the internet at https://afsp.org/suicide-statistics/

2. American Association for Marriage and Family Therapy. Suicide in the Elderly. Found on the internet at https://www.aamft.org/AAMFT/Consumer_Updates/Suicide_in_the_Elderly.aspx

3. National Alliance on Mental Illness. 2020 Health by the Numbers. Found on the internet at https://www.nami.org/NAMI/media/NAMI-Media/Infographics/NAMI_2020MH_ByTheNumbers_Adults-r.pdf

4. Centers for Disease Control and Prevention. Economic Cost of Injury — United States, 2019. Morbidity and Mortality Weekly Report (MMWR). Found on the internet at https://www.cdc.gov/mmwr/volumes/70/wr/mm7048a1.htm