There is sufficient evidence that Crisis Hotlines contribute to improved social outcomes and an increase in healthcare utilization for individuals experiencing behavioral health crises.
This assessment was made possible through support from Elevance Health. HealthBegins retains full editorial independence, and the content herein reflects its sole views and conclusions.
The findings below synthesize the results of the studies on Crisis Hotlines across three domains of measurement:
Behavioral health crisis support, particularly suicide prevention, is a critical public health need in the United States (U.S.). In 2024, 14.3 million adults reported serious thoughts of suicide, with 2.2 million attempting suicide, and approximately 5.5% of the adult population experiencing suicidal ideation[1]. In 2023, the national suicide rate was 14.7 per 100,000 people, with 49,316 Americans dying by suicide[2]. Particularly vulnerable populations include young adults between the ages of 18 and 25, who report suicidal ideation at a rate of 12.6%, and LGBTQ+ youth, of which 39% seriously considered suicide and 12% attempted suicide in 2024[3],[4]. 36.7% of young adults feel that their needs for behavioral health services are unmet, which may be a barrier to timely intervention and increase the risk of appropriate crisis escalation[5]. Similarly, only 18.3% of individuals who died by suicide had received inpatient behavioral healthcare[6].
The economic and healthcare impact of suicide and behavioral health crises is substantial. The annual economic cost of suicide and nonfatal self-harm was an estimated $510 billion in 2020 U.S. dollars[7]. Suicide attempts can result in hospital bills that exceed $175,000, with nearly 75% of the economic cost of nonfatal self-harm injuries being borne by people under the age of 45[8]. This creates additional social, emotional, and financial strain for people at risk of suicide, their families, and their communities[9].
Crisis lines provide on-call and confidential support to individuals experiencing behavioral health emergencies, connecting them with trained counselors who provide referrals to appropriate care and services[10]. During those interactions, responders work to reduce the psychological distress that callers may be experiencing and to de-escalate the crisis state. This includes connecting callers with local first responders when necessary and also providing resources and strategies to help them access treatments and engage in the care process[11].
A more recent example of such a service is the 988 Suicide & Crisis Lifeline, established through the National Suicide Hotline Designation Act of 2020, which provides critical behavioral health support and interventions through a three-digit national crisis hotline accessible 24/7 via call, text, and chat[12]. The line is staffed by trained crisis counselors and volunteers based in local crisis centers across the country. Since its July 2022 launch, the 988 crisis line has received 16.5 million contacts, which represents a 40% increase in volume compared to the previous hotline[13],[14]. Research demonstrates the usefulness of the crisis hotline, with 68% of users reporting receiving all or some of the help they needed and nearly 90% reporting that their conversation with crisis line staff and/or volunteers was helpful[15],[16].
From a policy perspective, federal law permits states to collect fees from telecommunications providers to fund 988 services, though not all states have implemented such a surcharge[17],[18]. States can leverage Medicaid administrative matching funds to support crisis call centers. In practice, states have adopted varying approaches to financing these services, including using a billing code for behavioral health hotlines[19]. However, as of 2023, only 22 state Medicaid programs covered crisis hotlines. This is, in part, due to challenges in obtaining insurance information during the call[20].
Despite the progress that the 988 crisis lines represent, there are still some challenges in providing comprehensive crisis support. One of these is the limited expansion of complementary crisis services such as mobile response teams, which provide on-site emergency response and psychiatric walk-in services. To provide a full crisis care continuum, comprehensive funding mechanisms and sustainable Medicaid reimbursement policies need to be in place[21].
Populations needing mental health support in Georgia. The 988 hotline use rates were drawn from publicly available data from Vibrant Emotional Health (a non-profit organization), the Substance Abuse and Mental Health Services Administration, and the Georgia Department of Behavioral Health and Developmental Disabilities.
The implementation of the National Suicide Hotline Designation Act of 2020. In October 2020, the Federal Communications Commission and Congress designated a new three-digit dialing code (988) for Americans to reach the National Suicide Prevention Lifeline and required states to adopt the Lifeline by July 16, 2022. 988 was intended to build on the infrastructure of the existing toll-free Lifeline number (1-800-273-TALK) but with an easier-to-remember number and broader directive: to provide 24/7 phone or text support for anyone experiencing a mental health crisis or in need of suicide prevention services.
Pre-post analysis.
Healthcare Cost, Utilization & Value: Between October and December 2021 and the same period in 2022, the number of calls grew from 63,314 to 69,380, representing an increase of almost 10%.
Callers to the National Suicide Prevention Lifeline who were at imminent risk of suicide.
Eight crisis centers in the National Suicide Prevention Lifeline network.
Descriptive analysis. N=491 call reports.
Healthcare Cost, Utilization & Value: Helpers actively engaged the callers in one or more collaborative interventions on 76.4% of the calls. Emergency services were sent with the caller’s collaboration on 19.1% of the calls. Active rescues (i.e., noncollaborative interventions) were implemented on 27.7% of calls. Most of these involved the more invasive procedure of sending emergency services (24.6%). Caller profiles and some helper characteristics (especially volunteer status) were associated with intervention type.
Lifeline callers and callers to the centers’ local lines who expressed suicidal ideation within 48 hours of their crisis call. Clients ranged in age from 18 to 78, with an average age of 36.8 years. Almost two-thirds of callers were female. 12.2% were Hispanic, 62.5% were Caucasian, 21.3% were African Americans, 6% Native American, 5.1% Asian, 0.4% Pacific Islander, and 10.7% identified as being of another race. The majority of the clients had completed at least some college or technical school; over 40% were unemployed; approximately one-quarter of the clients lived alone; and approximately one-quarter had been homeless as adults.
A national initiative to have crisis centers in the National Suicide Prevention Lifeline network provide follow-up care to callers who are at-risk of suicide.
Descriptive analysis and qualitative analysis. N=550.
Social: The majority of interviewed follow-up clients reported that the intervention stopped them from killing themselves (79.6%) and kept them safe (90.6%). Counselor activities, such as discussing distractors, social contacts to call for help, and reasons for dying, as well as individual factors such as baseline suicide risk, were associated with callers’ perceptions of the impact of the intervention on their suicide risk.
Individuals at risk of suicide. Two-thirds of crisis chatters were female, and almost 8% of the sample identified themselves as gender minorities. Nearly 40% were minors, and over 70% were younger than 24 years. Over half reported depression as the main issue for which they had contacted the network, with non-suicidal self-harm or anxiety each reported by one in 11 chatters. Current or recent thoughts of suicide were endorsed by over 80% of the chatters. Almost 60% of chatters reported that they were either very or extremely upset, while 30% indicated that they were moderately upset.
The National Suicide Prevention Lifeline’s Crisis Chat Network, which answers chats from hundreds of thousands of at-risk individuals yearly.
Pre-post analysis. N=13,130 linked pre-and post-chat surveys.
Social: Chatters were significantly and substantially less distressed at the end of the chat intervention than at the beginning. By the end of the chat, two-thirds of chatters at risk of suicide reported that the chat had been helpful, while just under half reported a reduced risk of suicide.
Adult callers to 12 Lifeline Crisis Centers between April 15, 2020, and August 15, 2021, who were at risk of suicide. The caller's current risk of suicide was identified by the Lifeline counselors based on their clinical risk assessment. Additionally, callers had to be at least 18 years old, English‐speaking, and located within the U.S. or the U.S. territory of Puerto Rico. Over half of the interviewed callers were female, and nearly three‐quarters were between the ages of 18 and 34. They were 64% White, 14% Black, and 5% Asian, with roughly 9% identifying as more than one race. The sample was approximately 15% Hispanic/Latinx. Just over half of the callers reported having made a suicide attempt in their lifetime prior to their Lifeline call. Over half reported being at least somewhat likely to act on their thoughts of self-harm through suicide at the time of their call. Approximately 40% reported they wanted to die more than live or definitely wanted to die. Less than half of the callers reported being in treatment with a mental health professional at the time of their Lifeline call.
988 Suicide and Crisis Lifeline.
Descriptive analysis. N=437.
Social: The vast majority of Lifeline callers who were at-risk of suicide thought their crisis call helped them (about 98%) and stopped them from killing themselves (88.1%). Callers' perceptions of counselor behaviors in fostering engagement/connection, collaborative problem‐solving, and safety assessment/management were strongly associated with callers' perceived effectiveness of the crisis call.
Callers presented with a variety of problems, including abuse/violence (10.8%), addictions (13.0%), basic needs (18.7%), interpersonal problems (67.4%), mental health (48.2%), physical health (13.4%), work (9.9%), and other problems.
Telephone crisis services/hotlines at eight centers in the U.S.
Pre-post analysis. N=1,617 crisis callers, of which 801 participated in the follow-up assessment.
Healthcare Cost, Utilization & Value: Out of the 1,617 callers who participated in the baseline assessment, 969 (59.9%) were given a new referral, 658 (67.9%) of which were to mental health resources. An additional 135 (8.3%) callers were referred back to their current therapist or services. Of the 801 callers who participated in the follow-up, 541 (67.5%) were given a new referral at baseline, 392 (72.5%) of which were to mental health resources.
An additional 75 (9.4%) callers were referred back to their current therapist or services. The overall referral rate for those who participated in the baseline was 68.3%, and the rate of referral for those who participated in the follow-up was 76.9%.
Of the 392 follow-up crisis callers who were given a new mental health referral, 33.2% had kept or made an appointment with a mental health service in the period between the initial call to the center and the follow-up assessment.
Social: Callers’ distress, as assessed by the total score on the Profile of Mood States (POMS-M), was significantly reduced from the beginning to the end of the call. There was also a significant reduction in these POMS-M domains: confusion (p<0.001), depression (p<0.001), anger (p<0.001), anxiety (p<0.001), helplessness (p<0.001), and overwhelm (p<0.001). Similarly, there was a significant reduction in callers' level of hopelessness (p<0.001).
However, the crisis callers who reported suicidal thoughts at baseline were significantly more distressed than other crisis callers at follow-up.
Digital hotline participants in a Southern state.
A digital hotline service developed collaboratively with community partners serving survivors of interpersonal violence in large agencies operating in urban areas in Texas. Both agencies provided comprehensive services, including a 24/7 dedicated phone hotline, shelter, counseling, services in English and Spanish, and post-shelter housing. Both agencies had been providing digital hotline services via chat and text for at least three years.
Descriptive analysis and pre-post analysis. N=37.
Health: No changes were observed for physical health.
Social: Six weeks post-digital hotline use, depression and post-traumatic stress disorder (PTSD) symptoms had significantly decreased, and hope and feelings of safety had significantly increased.
Repeated hotline use after baseline was associated with revictimization, sustained health needs, and reduced perception of internal tools related to safety.
Individuals calling mental health emergency hotlines in the United States. Approximately half of the included studies (N=25) focused on descriptive information of callers, most of whom were females, younger adults, and White. Veteran hotlines typically reached older men. Common reasons for calling were the risk of suicide, depression, and interpersonal problems.
U.S.-based telephone, text, and chat mental health emergency hotlines.
Scoping review. The review included peer-reviewed articles on U.S.-based telephone, text, and chat hotlines published between January 2012 and December 2021. 1,049 articles were retrieved. In total, 96 articles met the criteria for full-text review, and 53 of those met the full inclusion criteria.
Social: Of the studies examining intervention effects (N=20), few assessed hotlines as interventions (N=6), and few evaluated caller behavioral outcomes (N=4), reporting reduced distress and reduced risk of suicide among callers after hotline engagement. However, these studies also suggested areas for improvement, including reaching underrepresented high-risk populations such as LGBTQ+, rural, and Indigenous populations.
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[15] Saunders, H. (2025, July 14). Demand for 988 Continues to Grow at Third Anniversary. KFF. https://www.kff.org/mental-health/demand-for-988-continues-to-grow-at-third-anniversary/
[16] Gould, M. S., Lake, A. M., Port, M. S., Kleinman, M., Hoyte-Badu, A. M., Rodriguez, C. L., Chowdhury, S. J., Galfalvy, H., & Goldstein, A. (2025). National Suicide Prevention Lifeline (Now 988 Suicide and Crisis Lifeline): Evaluation of Crisis Call Outcomes for Suicidal Callers. Suicide & life-threatening behavior, 55(3), e70020. https://doi.org/10.1111/sltb.70020
[17] Hepburn, S. (2025, May 13). Service Fees, Behavioral Health Equity, and Funding 988. #CrisisTalk. https://talk.crisisnow.com/service-fees-equity-and-funding-988/
[18] Purtle, J., Chance Ortego, J., Bandara, S., Goldstein, A., Pantalone, J., & Goldman, M. L. (2023). Implementation of the 988 Suicide & Crisis Lifeline: Estimating State-Level Increases in Call Demand Costs and Financing. The journal of mental health policy and economics, 26(2), 85–95.
[19] Lawson, N. (2024, September 13). What State-Level Data is Available for the 988 Crisis Line? Center for Children and Families. https://ccf.georgetown.edu/2024/09/13/what-state-level-data-is-available-for-the-988-crisis-line/
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