Editor’s Note, 11/27/23: This article was edited to clarify that although geolocation is not technically in use by #988, it can still be used to track callers through a partnership with #911.
#988 first appeared in a report to Congress in August 2019 wherein Federal Communications Commission (FCC) staff proposed it as a nationwide, easy-to-remember calling code for people who were suicidal or otherwise in emotional distress. Approximately one year later in July 2020, the FCC adopted rules to begin establishing #988, and in October of the same year, the National Suicide Hotline Designation Act was signed into law. Additional rules were adopted in November 2021 that required #988 to also be available by text.
Since then, many have spoken about #988 like it’s the next new cure. The rollout has been a big deal met with plenty of fanfare, and hundreds of implementation meetings across the nation. Webinars, conferences, and marketing plans have also centered it. More than one state in the US has introduced legislation to get #988 on the back of student ID cards, and on signage near bridges. At least two states have introduced legislation suggesting signs be posted at the top of multi-level garages that read “You are not alone” followed by those increasingly infamous numbers: 9-8-8.
But Does #988 Really Live up to the Hype?
Spoiler Alert: For the “too long/didn’t read” set, I’ll boil it down. No, #988 is not some grand fix to all our suicidal ills. There are inevitably some times when someone answering #988 has been helpful to someone calling in distress. But, on the whole, it appears to be more of the same system that’s been failing us, just on a much bigger “more accessible” scale. Although it professes to divert calls away from carceral responses, there’s evidence it may actually be increasing involuntary interventions. In my own case, it landed me with three cop cars outside my house, and my needing to do a bit of a verbal dance to get them on out of there without further negative consequence while my 11-year-old freaked out in the background.
When evaluating #988, there are so many questions worth considering:
- Is #988 actually something different, or is it just the same old stuff repackaged?
- Was access really the biggest problem with the way things were?
- Is something always better than nothing?
To some degree, the answers to those questions will depend on who you ask, but it’s not all a matter of opinion. Too often, the public tries to opinion away what are actually facts, and there are some real facts worth considering on this matter.
Vibrant Emotional Health (Vibrant) is described as “one of the nation’s leading mental health organizations.” They are also the administrator of #988. In October, 2022, I had the opportunity to attend #CRISISCON in Kansas City, Missouri, and listen to a plenary presentation from Vibrant administrators about how great everything was going. (This is also the same conference where I listened to a workshop presenter go on at length about the “suicide tumor,” but that’s a story for another time.)
The presenters had slides dedicated to the positive feedback they were receiving from people calling in. According to them, people were, of course, very, very satisfied.
[FACT ALERT] At some point, I asked them to address the reality that people are routinely found to lie when responding to questions about how helpful a particular support was to them (they are inclined to say it was helpful even when it was not, and likely even more so when their freedom might hang in the balance). Vibrant ignored me.
As if to prove my point, a CNN article published one year later on October 31, 2023 reported the following:
“People with severe psychological distress were more likely than others to have heard of 988 and to have used the lifeline, according to research published Tuesday in JAMA Network Open. But overall, only a quarter of people said they would likely turn to 988 in the future if they or a loved one were experiencing a mental health crisis or suicidality – and less than a third of people with severe psychological distress who had already tried the lifeline were likely to use it again.”
Back at the conference, a smattering of folks across the presentation hall (filled with hundreds of conference goers) nodded or murmured in agreement with me when I challenged both that and the desirability of “geolocation.” (Geolocation is an approach that can help route calls to the geographically appropriate region based on the current location of the caller rather than simply on their phone number’s area code, but could also potentially be used to locate a specific person. It is not currently in use by #988 directly, but can still be accessed through partnerships with #911.) But, most stayed silent, except to offer me a chair because there are few groups more uncomfortable with my taking off my shoes and sitting on the floor in a crowded conference center than a roomful of clinicians.
I left the talk feeling like I was being sold on something. Marketed to. I still wasn’t buying it.
Secret Shopping Isn’t Just for Dunkin Donuts and McDonalds
I was around 20 when I first got involved in the world of Secret Shopping (aka Mystery Shopping). Secret Shopping basically involves showing up to a particular business and posing as a regular customer while taking notes (and sometimes pictures) for a report. It’s meant to be used as a training tool for employees, though occasionally also serving as a method to evaluate specific workers for bonuses (I try to stay away from those ones as it feels oppressive to me).
Over the years, I’ve completed hundreds of mystery shops at Dunkin Donuts, McDonalds, and various bank branches. I’ve stayed at hotels and timeshares, ate at fancier restaurants, took an exam to become certified as a dental hygienist, learned about truck driving school, and was once even drug tested at an occupational health facility all under the secret shopping umbrella. But never have I ever ‘secret shopped’ anything in the ‘mental health’ world before. That was about to change.
Early on, when I first heard about #988, I decided to recruit for a group that would be willing to embark on a secret shopping experiment with the line itself. However, the overwhelm of the pandemic kept me from following through. Yet, as I contemplated the heavy Vibrant presence at CrisisCon 2022, I decided to do a little ‘shopping’ on my own.
It was Wednesday, October 19, 2022. I decided to try texting #988 rather than call. It’d make the ‘secret shopping’ piece a bit easier to start.
Sueanne was my first.
“Hello, my name is Sueanne. How can I support you today?”
Sueanne pretty immediately started asking me questions about whether or not I was suicidal (something about which I’d already been questioned a la an autoresponder at the start). I pushed back, and asked why Sueanne was asking those questions.
Sueanne: “Because this is a suicide chat line, these are questions we need to ask.”
Me: “Well, what if I don’t want to answer?”
Sueanne: “That is your choice.”
Okay. Not bad. Sueanne switches gears:
“Can you tell me why you are tired, and you don’t see a way out?”
This was a reflection of how I’d answered when asked how Sueanne could “support” me. As stilted as it was in its way, it at least reflected an attempt to use my language. However, it wasn’t long before Sueanne resorted to the same old “you should get a therapist” recommendation. Willingness to just be present and validate was limited.
This may have been because Sueanne was talking to up to ten people at a time.
Yes, the main thing I learned from Sueanne—who was sometimes taking as much as four or five minutes to respond to me—was that #988 text responders can talk to multiple people at once.
I tried #988’s texting feature again later that same day. Simone was my second.
It’s hard to say much about Simone, though, because right after I was asked about being suicidal, the call dropped.
Since attempt number two was kind of a bust, I gave it a third go. This time I got Taylor. Taylor was actually the highlight of my #988 experience, at least to date. Sure, there were some scary questions early on like:
“Can you tell me where you are now?”
But, when I gave a vague answer, Taylor didn’t push. And, when I said things that might have sent some folks into a suicide-prevention-driven panic for reading too much into my words… like “I’m just so tired. I wish I could just sleep”… Taylor simply explored what was going on, and if I was having trouble with insomnia. I was then offered a couple of web resources, and encouragement to check things out with my doctor to see if there might be a medical cause to my inability to sleep.
Taylor even apologized for the disconnect that had happened with Simone earlier, and thanked me for being willing to take a risk and try again. Mental health system providers rarely apologize, so that was meaningful even if only a small thing.
Toward the end of the interaction, Taylor walked me through creation of a ‘safety plan.’ This segment of our call started with an awkward question:
“Are you able to stay safe from suicide tonight?”
That honestly felt a little disconnecting, but Taylor saved things with one of the more skillful responses I’ve heard out of a suicide prevention line.
Me: “I mean what would you do if I said no or I wasn’t sure? I don’t want anyone trying to take control or lock me up or something.”
Taylor: “I would ask if you would be open to making a plan to stay safe. I don’t want to take control from you either, My goal is to keep you safe in the least intrusive way possible.”
Me: What does a plan like that look like?
Taylor: “It usually includes identifiable stressors, ways to distract yourself, social supports, professional supports, a safe place and one thing to remember when you are in crisis. We could do an abbreviated plan since you are so tired.”
I said okay, and Taylor walked me through a handful of questions like identifying two hobbies or activities that help me relax, and something I’d want to be reminded of when suicidal thoughts get bigger. When Taylor asked me to identify people I could reach out to, and I said I really didn’t have anyone, Taylor didn’t balk.
“That is ok, not every plan looks the same. Do you think that you would be open to reaching back out to #988 … if you were in crisis again?”
I said “I guess,” and Taylor accepted that.
At the end, Taylor sent me a summary of the plan. I noticed something that didn’t reflect what I’d said, and Taylor corrected it. We said our goodbyes and the call ended.
All told, the interaction was pretty good… though given subsequent interactions, I have to wonder what Taylor would have done if I hadn’t said I was out of town, or hadn’t been willing to engage in safety planning.
In truth, I don’t actually find ‘safety plans’ all that useful. Frankly, they can be pretty annoying and further exhausting when I’m already exhausted from being in a dark place. Safety plans also have the potential to be shaming and lead to secret-keeping if, for example, the plan suggests we shouldn’t do something that we end up doing (or never really felt committed to not do in the first place).
In the end, I was doing the plan for Taylor’s sake, not mine. Appeasing the provider – especially if the person receiving services likes, feels sorry for, or is afraid of them – is a surprisingly common thing that people in the ‘patient’ role do.
I texted #988 again on Thursday, October 20 while I was sitting and listening to another plenary presentation at CrisisCon.
“You’ve reached #988, this is Gretchen, what’s on your mind today?”
I decided to focus on self-injury this time.
My conversation with Gretchen didn’t go well overall, but I will give credit where credit is due. Before we even got through more than two questions, Gretchen said something I don’t recall seeing from others with whom I’d spoken:
“I am glad you reached out for support today. Our conversation will be confidential, however I do need to inform you that we have an obligation to protect you or someone else if we learn of serious risk of harm, or if the law requests us to disclose the information.”
Okay, at least there was some transparency. That said, as I began to challenge Gretchen on running through the standard suicide assessment questions in a way that seemed like a ‘cut and paste,’ the theme of “if you can’t stay safe, we might have to act” continued to surface.
“I understand how it can seem like cut and paste. That is because it is and it is a requirement for each counselor to ask. I do not have any plans to send anyone to you to take you away unless you are actively harming yourself or feel you are not able to keep yourself safe.”
The door to talk about self-injury had been opened, and so I walked through it.
“I mean I’m cutting myself but that’s not the same as suicide. You don’t send people for that do you? This is feeling scary.”
Gretchen ignored my question, and instead replied:
“Can we put down what you are using to cut and move away from it so we can talk more about how you are feeling?”
I didn’t care for the ‘we’ language. I received it as condescending and paternalistic. So, in a moment of wit, I feigned surprise and told Gretchen I didn’t know that Gretchen was cutting, too, and while we were both free to stop, I wasn’t going to. Gretchen wasn’t amused. I kept pushing, and frankly, trying to educate a bit, too.
Me: “We can talk whether or not I stop can’t we?”
Gretchen: “We can, can you share with me what is keeping you from putting down what you are using to cut with?”
Me: “Because it helps. I guess I’m curious why you think its important to put it down.”
Gretchen: “I find it important for you to put it down because I want to be able to keep you safe and find different activities to use that maybe able to help.”
Gretchen didn’t take the cue to move on from the self-injury talk, and kept pushing, and centering the responsibility for my ‘safety’ in others, rather than myself. This was a familiar approach. I needed someone to ‘keep me safe.’ I was powerless here.
This was hitting close to home. It was basically the same sort of conversation I’d had with a therapist who ultimately forced me into a psychiatric facility over “keeping me safe” from self-injury that she (incorrectly) perceived to mean I was high risk for suicide.
The biggest problem? That was more than 25 years ago.
Apparently, nothing has changed.
I lapsed on my secret shopping mission for several months. Maybe because things with Gretchen had too many echoes of my history of involuntary trips to psychiatric facilities. Maybe because I just got busy. Maybe a little bit of both.
However, on Friday, June 2nd, 2023—during a virtual meeting with fellow advocates where the #988 topic arose—I felt inspired to give it a go again.
“Hi I’m Jen, I am glad you reached out to #988 today. Is there a name you would like me to use while we talk or you may remain anonymous?”
I immediately said I’d remain anonymous. Jen accepted that (“Of course.”) and asked me “What made you chat in today?”
I decided to push the limits. Again, I was suicidal, and when asked if I had a plan, I said I had a lot of pills.
Jen: “Do you have them now?”
Jen: “How about putting them somewhere else while we talk? Maybe in another room?”
Me: “No, thanks. Right now self injuring is helping.”
Jen: “What are you doing to self-harm right now?”
Jen: “How about we talk about some safer ways to help?”
This was Gretchen all over again. Maybe worse.
[FACT ALERT] I get that self-injury scares people, but shouldn’t individuals in the business of offering this type of support have learned some better ways to respond by now? If someone says something is helping, explore how it’s working for them. Even if it makes you uncomfortable. Don’t just jump to trying to take it away. And especially, don’t go there when that person is in the midst of a crisis. What a terrible and downright dangerous idea.
I pushed and tried to educate again.
Me: “If this works, why would it make sense to stop it?”
Jen: “In order to more safely cope with what is going on in a way that does not cause you harm.”
Me: “Look, this is working for me right now. Your idea of ‘safe’ would put me at more risk of dying.”
Jen let it go at that point, and finally asked why I was self-injuring. Now we’re getting somewhere. But, truth be told, I was trying to respond more or less as I would if I were really in the crisis I described. Having to defend the self-injury once again made me tired and sad for how little progress has been made over so many years.
Before too long, Jen circled back.
“You mentioned earlier that you were cutting and it was helping. I want to ensure you and I can continue talking so I can best support you. Are you currently bleeding?”
I said I was, and Jen asked if I needed medical attention. I was clear that I did not. I found myself wondering—just as Taylor had suggested sleep resources for insomnia, what if Jen had offered information on safer self-injury? My guess is that Jen has no idea such harm reduction resources exist.
I decided I really wanted to end the conversation. I resisted Jen’s not-so-subtle effort to get me to name some future plans to signal I planned to keep existing. Unlike Taylor with whom I’d been able to develop a little bit of trust and rapport, I had no such feelings with Jen.
Jen: “I just want to make sure I understand, do you want me to end this interaction now?”
Jen: “We are here for you 24/7 if you want to reach out to us again.”
The call ended. Shortly thereafter, I left my office in Holyoke, Massachusetts, drove a town over, picked up my child from school and went home.
My call with Jen had ended at 4:41pm. Well over an hour later as I’m at home making dinner for my 11-year-old, I hear a loud pounding sort of knock on my front door. It’s the kind of knock that can be associated with few other than the police.
My mind starts racing. I was at work when I called! The phone I used is registered to my employer’s address! How did they find me here? I said I wanted to stay anonymous. It’s been a while since that call ended. Why would they be coming now? Jen said “We are here for you 24/7 if you want to reach out to us again!” If Jen was thinking of sending someone, why didn’t that get said, or at least some concern expressed about signing off?
I walk to the front door and open it. There’s a police officer standing there, with three cop cars parked on the street in front of my house. He asks me to step outside. My 11-year-old is alarmed and asking why the police are there. I suspect my child thinks it has to do with the fact that they’ve been refusing to see their father in spite of court ordered parenting time. I feel really bad that they’re worried.
The police officer tells me what I already had surmised: They’d come to do a wellness check on me because of my conversation with #988. He motions to the other cops to hold their position, seemingly barely keeping them at bay at the edge of my driveway. Clearly – and in spite of Jen suggesting I would get to remain ‘anonymous’ if it was my wish – they’d just looked up my number, found it associated with my name (which they already had when they greeted me at my door), looked up my home address and were on their way. (Well, over an hour later… which leaves me wondering what they really thought they were going to accomplish if I’d actually been on the verge of making an attempt.)
I decided on the fly that things would probably go better for me if I came up with a story other than secret shopping, so I told them that I’d been at work and had been supporting someone else that I’d allowed to use my phone to dial #988. That wasn’t enough. They wanted proof of where I worked. I thought fast and searched for a flyer on Facebook of an event where I’d spoken earlier that week. I handed my phone to the officer so he could see my image and bio on the flyer stating where I work and verifying at least that part of my story.
The cops leave. I go inside and my child questions me. I explain more or less what happened. My child looks at me incredulously and says, “They sent the cops because they thought someone was suicidal?”
Yes. Yes, they sure did.
The Real Risk of Harm
I talked my way out of this “wellness check” just like I did back in 2019 when the ASIST Suicide Prevention trainers called the cops on me after I posted an angry statement on Facebook criticizing their behavior and suggesting that it was such actions that led people to kill themselves rather than reach out for help. But, what of people who can’t talk their way out either because they don’t have the experience to know the right words, or because they’re truly in a moment of struggle?
In order to have that conversation we need to consider not only the short-term impact of being taken by police and incarcerated involuntarily in a psychiatric facility, but the long-term outcomes associated with that having happened.
Not long after my incident with Jen, a debate ensued on a listserv to which I subscribe about the efficacy of #988. One person exclaimed:
I am not troubled by the increase in hospitalizations. The upside of the involuntary hospitalization numbers is that fewer people are likely dead of suicide. Many others are receiving the care they need.
There are so many assumptions wrapped up in that. He continued:
Let’s admit that the post-call fate of the individuals referred for care (voluntary or not) is not known. Are these people still alive, are they in a recovery process, is their life better? We have no data one way or another.
[FACT ALERT] He’s wrong about that. There’s actually a growing body of evidence that says that suicide risk stays elevated for as long as two years after being held on a locked psychiatric unit, particularly when the stay was involuntary. In fact, recent research also suggests that even when there’s the perception of coercion—never mind outright force—suicide risk increases.
Furthermore, a high percentage of people who experience this sort of ‘intervention’ (along with those who witness or are aware of the potential) simply don’t feel it’s safe to reach out to anyone at all.
Not Just Secret Shopping
On July 29, 2023, just past midnight, Emily Wu Truong called #988. She was in search of emotional support after having just been faced with a moment of extreme shock. She was experiencing suicidal thoughts, but had no plan to act on them.
Unfortunately, while nationally recognized organizations like Didi Hirsch continue to make claims that only a small percentage of #988 calls will result in a 911-type intervention, there are clear signs they are minimizing the reality. For Emily, her #988 call led quickly to involuntarily hospitalization that lasted for 50 hours. She was held against her will in a local Emergency Room and then transferred to Kaiser’s psychiatric facility on College Street in Los Angeles, California. She was deemed a potential suicide risk by an officer from the Arcadia Police Department (APD) who used little time or skill to draw that conclusion. (Emily was later able to confirm that the APD had received no recent relevant training.)
This incident followed close on the heels of other unhelpful #988 exchanges Emily had previously had. For example, in February 2023, she’d texted #988 to inquire about support groups in Asian languages. The person answering the text inquiry (“Cam”) didn’t explore at all if Emily was struggling or seeking the groups for herself or others, and disconnected the call while Emily was still attempting to converse.
Such prior interactions had already left Emily questioning #988’s promises of help, but her July interaction left her horrified and traumatized. On September 5, 2023, Emily shared her story with California’s Mental Health Services Oversight and Accountability Commission (MHSOAC). A moderator cut Emily short in the midst of a tearful moment, after which she was thanked for her input. It was unclear how seriously anyone at the meeting took her statement.
As a result of what happened, Emily has lost complete confidence in a system whose intention should be to create conditions that support people’s lives and ease their pain. Out of ignorance, the California legislature created the Welfare & Institutions Code, which broadens the number of people with limited training who can take away anyone’s individual freedoms without question. There was no due process for Emily. There weren’t even any mental health clinicians present when first responders decided to take her into custody. Every single person involved with the 5150 process (the California code that allows for the detention of individuals perceived to be “mentally disordered” and at immediate risk)—and like processes in other states—risks becoming complicit in harming already-traumatized people, too often leaving lifelong emotional scars.
Emily’s traumatic experiences from this 5150 has also left her facing demands for payment of over $2,800 from different agencies related to the hospitalization to which she never consented. These agencies have set a deadline of December 31, 2023 for payment. If not paid, these agencies have indicated that the bills will be sent to collections and affect her credit score.
Little is more telling of the impact of this #988 incident than Emily’s own words on her Facebook page:
“I can never trust the so-called mental healthcare or healthcare system. The system has nothing to do with health nor care! I am sooooo effing traumatized that I will never ever call #988 again nor use 911 ever. I choose to die in my own home.”
Emily is far from alone. Her horrifying experience has left her feeling doubtful that the system will ever change. However, her newfound faith in spirituality leads her to try to remain hopeful and continue educating others about how broken the system is, and how much we need to come together to change it for the wellness of our entire community.
Back to the Beginning
At the start of this piece I said there were three things worth evaluating when looking at #988:
- Is #988 actually something different, or is it just the same old stuff repackaged?
- Was access really the biggest problem with the way things were?
- Is something always better than nothing?
The answers now seem clear. #988 isn’t something different. It’s just a lot more of the same. While #988 is under no particular obligation to be the alternative for which many of us yearn, one has to wonder if it is sucking up all the funding oxygen that might support some of those alternatives to exist?
Meanwhile, access has surely been an issue, but we need to continuously ask, “Access to what?” That matters at least as much, because no, sometimes something isn’t better than nothing.
If that something takes your freedom and teaches you that silence is the only choice, it can actually be much, much worse.
I want to acknowledge that—since I’ve begun sharing this story—some people have been quite upset to learn that I’ve been “secret shopping” #988. They fear I’m taking up needed #988 bandwidth for folks who have a valid reason for calling (they are truly in crisis), and one person also worried that #988 workers’ feelings might be hurt by my method of collecting data. These folks have suggested various alternative approaches such as calling the people who operate #988 lines to ask if I can sit in on calls, or role play out with them how they’d handle a situation. In response, I offer the following:
Checking out what #988 is like so I can support my community to make an informed decision about whether or not to call is a valid reason, especially given all that is at stake. Period.
There are many people who will never call a line that poses a threat to their freedom. That point routinely gets lost in these conversations. Folks who fear calling #988 deserve support, too.
I’m not going to call #988 administrators to beg them to give me the information I’m seeking. If #988 administrators valued the input of people like myself, they would have asked for it in the first place. In most areas, they did not. I have no reason to trust they’d be responsive or honest in what they did provide, especially when all signs point to them doing their best to market #988 as an invaluable service. I’m not going to work extra hard to get through the front door, when I can get much more timely and honest answers going in the back.
I also can’t muster much care for the hurt feelings of people who hold enough power that they can have cops show up at my doorstep contemplating whether or not to take my freedom away. They should be far more accountable to their actions than they are, and if they are sad about that, it’s just not my problem.
I promise you, I’m not calling a lot. No more than I’ve stated here. There’s plenty of space left for people in actual crisis (for better or worse).
But… I will be calling again… Once I have a burner phone!
Contributing Editor’s Credit – Emily Wu Truong: Emily Wu Truong is a 2nd generation Taiwanese American mental health advocate, community organizer, an award-winning storyteller for emotional resilience and healing, visual and performance artist. Since 2010, her efforts to raise community mental health awareness have helped to educate thousands across the country to find meaning in their life struggles and become more understanding of individuals with emotional struggles. Emily’s story has been featured by the California Mental Health Movement Each Mind Matters, Fox 11 News, Good Morning America, NBC Asian America, LA 18 and the World Journal Chinese Daily News (世界日報). Emily has been recognized for her grassroots advocacy from Congresswoman Grace Napolitano, Congresswoman Judy Chu, Senator Ed Hernandez, the Los Angeles County Board of Supervisors, Assemblyman Ed Chau & Assemblyman Mike Eng. Currently, Emily serves as a steering committee member for NAAPIMHA’s National Asian American Pacific Islander Empowerment Network (NAAPIEN) to provide safe spaces for marginalized AANHPIs in a world that is less compassionate. Emily also serves as a support group facilitator for the NAMI Greater Los Angeles County also known as NAMI. Emily has become a role model for many, sharing her life lessons to encourage others to find the light at the end of the tunnel.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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