Reflections on 988 Day from someone who helped build the Suicide Prevention Lifeline foundation and is now focused on what happens after the cal.l
Today marks 988 Day—a moment to celebrate how far we’ve come and envision where we’re headed in transforming crisis intervention services across America. As someone who spent 18 years as the founding Executive Director of the National Suicide Prevention Lifeline and helped launch the 988 Suicide and Crisis Lifeline in 2022, I find myself reflecting not just on what we built, but on what we’re building next in behavioral health crisis response.
How the 988 Lifeline Foundation Was Built
When we began constructing the National Suicide Prevention Lifeline network over two decades ago, we were essentially creating it on the backs of a little over 100 local crisis centers around the country. These call centers were not being paid by our organization, SAMHSA or their states to join this national network. Rather, they agreed to membership simply because they all shared a common commitment: to prevent suicide locally and nationally.
Fueled by advisory inputs from crisis center directors, national experts in suicide prevention, persons with lived experience and ongoing evaluations of their work, together we established consensus best practices for crisis contact centers that have been shown to save lives. Subsequently, the National Suicide Prevention Lifeline’s proven effectiveness and innovative methods led to the FCC’s historic decision to assign us a 3-digit number, while also influencing crisis service practices worldwide.
Today, the emergence of 988 has elevated the role of crisis contact centers to major players in state leadership plans for transforming their behavioral health care systems. Ten years ago, Lifeline’s under-funded network call centers were struggling to keep up with calls, with approximately 1/3 of calls flowing from states to our better-funded national back-up centers. A 2014 network survey showed that 82% of our centers were funded at less than $500k annually, with about 26% receiving less than $200k a year. Today—as reported in a 2024 survey of states published by the NASMHPD Research Institute (NRI) in July<—the average annual state funding for the 200+ network centers is over $3m, more than 6 times greater than a decade ago.
Moving Crisis Services Beyond the Front Door
By the time 988 launched in July 2022, we had built something remarkable—a robust network of crisis contact centers that could provide “someone to contact” for anyone in crisis, 24 hours a day, seven days a week. The 988 network was mature, tested, and ready to scale. But as I looked ahead, I realized that—while the network foundation was complete—the real work was just beginning. We had built an exceptional “front door” to mental health crisis support, but many people needed more than a phone call, text, or chat to address their behavioral health crisis.
That’s when I made the decision to leave the Lifeline and join Behavioral Health Link, a company that has been revolutionizing broad scale community crisis care coordination for over two decades.
SAMHSA recognized that funding 988’s crisis center capacity was our top priority so people in crisis would have “someone to contact” when it launched, but subsequent years would need to expand systems to enable “someone to respond” (mobile crisis teams) and “a safe place to go” (community-based crisis receiving facilities). In SAMHSA’s 2021 Appropriations Report to Congress, they shared the agency’s aspiration to have “80% of individuals nationally to have access to mobile crisis services by 2025” and by 2027, for “80% to have access to community-based crisis care” receiving facilities. Those goals appeared wildly optimistic at the time, and in retrospect serve to remind us that 988 is very much in its toddlerhood; we are far from replicating the scale and breadth of service response, receiving and coordination capabilities of 911.
Nevertheless, NRI’s recent state survey reveals substantial growth “beyond the front door” of 988. In 2024, states reported a 37% increase in mobile crisis services (2,111 teams) and a 108% increase in crisis stabilization services (794 programs). Their data suggest that all states now have some mobile crisis and crisis stabilization services, with 34 states having statewide availability of mobile teams and 25 states reporting “state-wide access” to crisis stabilization facilities. If these annual growth rates continue, it appears reasonable to project that all states could achieve state-wide coverage for “someone to contact,” “someone to respond” and “a safe place to go” by 2030.
Crisis Care Coordination: What’s Still Missing in 988 Systems
If it’s possible that the nation could have every state with state-wide coverage for all 3 pillars of crisis care by 2030, why do I say 988 is only in its toddlerhood? Presuming all pillars of crisis care are in place and properly resourced for every state, there remain two major components missing:
Care coordination and continuity to support people throughout their crisis care journey. Services are not connected with each other in ways where they interoperate and share data about individuals they’re caring for across services. Only 27 states have 988 dispatching mobile crisis services, and many states have multiple access points for crisis care calls, mobile crisis dispatch, and crisis stabilization facility placement. While NRI’s survey describes one state’s reporting of data that shows how contacts are resolved at crisis center, mobile crisis, and crisis stabilization levels, only 4 states are reporting outcomes on all of these components.
Evidence-informed best practices for mobile crisis services and crisis stabilization programs, similar to what we developed for 988 crisis call centers. Currently there’s no evidence showing us what processes and activities mobile crisis teams undertake that directly impact reducing a person’s distress, their level of risk, and their ability to connect to care when needed. Best practices require program evaluations, and to evaluate programs across a state, we must have common data elements to track and measure.
Behavioral Health Link pioneered the U.S.’s Crisis Now “air traffic control” model for crisis care coordination, and our software platform is now supporting crisis coordination in 13 states across the country. The technology exists to enhance service coordination, however, local relationships between crisis providers and public behavioral health policy designed to reinforce care coordination are also essential.
As for program evaluations that can identify best practices, SAMHSA established a five-year 988 Suicide & Crisis Lifeline and Crisis Services Evaluation beginning last year, and I am honored to be on the Evaluation’s Advisory Committee. While I have no doubt these evaluations will be “the gold standard,” it will likely take years before we have meaningful results that will influence national protocols and practices. Further, the evaluation will extract data from 9 states with the intent of extrapolating lessons learned, but the other 41 states will still have unique challenges and resources that will require more direct analysis of their programs and services to systemically improve quality.
Future of 988 Crisis Response: 2030 Projections and Beyond
On this 988 Day, we should celebrate what we’ve accomplished. Every state now provides “Someone to Contact” through 988 contact centers, and we’re rapidly expanding mobile crisis and stabilization services nationwide.
But let’s also commit to what comes next: ensuring that every person who reaches out for help gets not just someone to talk to, but the right level of care, delivered at the right time, in the right place. That’s how we transform crisis response from a safety net into a springboard—helping people not just survive their crisis but emerge stronger and more connected to ongoing care.
The 988 network we built over 18 years created the foundation. The crisis coordination systems we’re building now will determine whether that foundation supports a transformed behavioral health system that truly serves everyone in need.
Frequently Asked Questions About 988 Crisis Care
What is the 988 Suicide & Crisis Lifeline? The 988 Suicide & Crisis Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week, across the United States.
How do mobile crisis teams work with 988? Mobile crisis teams provide on-site crisis intervention services when someone needs more than phone support. Currently, only 27 states have 988 directly dispatching mobile crisis teams, though this coordination is rapidly expanding.
What are crisis stabilization services? Crisis stabilization facilities provide short-term residential crisis care as an alternative to psychiatric hospitalization. These programs have grown 108% since 988’s launch, with 794 programs now operating nationwide.
How has 988 funding increased since 2022? Average annual state funding for 988 network centers has increased from less than $500k a decade ago to over $3 million today—more than 6 times greater investment in suicide prevention infrastructure.
Dr. John Draper is President of Research, Development & Government Solutions at Behavioral Health Link, Inc. and the founding Executive Director of the National Suicide Prevention Lifeline (now the 988 Suicide and Crisis Lifeline).