Iowans continue to seek mental health support two years after launch of 988 hotline

In the two years since the National Suicide Prevention Lifeline shortened its 10-digit number to 988, more Iowans are dialing the number in times of crisis.

More than 26,000 Iowans sought mental health support by contacting 988 by phone, text, or chat between May 2023 and May 2024, according to the 988 Suicide & Crisis Lifeline’s website.

That’s a slight decline from the 31,000 Iowans who called 988 in its first year — from July 2022 to July 2023 — but still significantly more than the roughly 12,000 Iowans who called the National Suicide Prevention Lifeline annually before the phone number was shortened.

"Since (July 2022), our day-to-day operations haven't changed much besides the volume of people reaching out to us has increased substantially," said Emily Blomme, chief executive officer of Foundation 2 Crisis Services, based in Cedar Rapids.

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How does 988 work?

When a person with an Iowa area code or IP address calls or texts 988, they are routed to either Foundation 2 or CommUnity Crisis Services in Iowa City, which provides support through a 24/7 hotline with crisis counselors. Counselors communicate with callers in an attempt to resolve the situation and can connect with emergency services if further action is needed.

The statewide goal is to respond to all 988 calls and texts within 30 seconds, with 90 percent of those responses being from Iowans. If an Iowa-based counselor is not available to respond within that time, the call is routed to a crisis counselor in another state.

"We let people define what a crisis is when they call us," Blomme said. "It could be someone dealing with a death in the family, a relationship issue, job loss, and it can also be that they're experiencing suicidal thinking."

The crisis line, launched in 2005, is administered by Vibrant Emotional Health on behalf of the U.S. Substance Abuse and Mental Health Services Administration.

Why are more people calling 988?

Blomme attributes the increase in calls and texts to the shortening of the lifeline number and public information campaigns that have put the number in high-risk locations such as bridges and the tops of buildings. In Iowa City, the numbers have been put on the sides of police vehicles.

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"When people are in crisis, their minds don't always think as coherently, and having to remember or search to find a 10-digit number caused some unneeded stress on these individuals," she said.

Blomme also attributed the rise in calls to a decrease in the stigma around mental health since the COVID-19 pandemic.

"We call the pandemic a shared traumatic experience because we were all in it together,” she said. "With all the isolation and depression that came from the pandemic and people experiencing so much fear and anxiety, we had many individuals reach out saying they had never experienced mental health challenges like this before."

Pew Research Center reported that from March 2020 to September 2022, 41 percent of U.S. adults said they had experienced high levels of psychological distress at least once since the early stages of the pandemic.

"The silver lining of (the pandemic) is that crisis and mental health issues were so prevalent that people had to address it, and more people were and are reaching out," she said.

Challenges persist

While the increase in calls to 988 over the last two years means more people are reaching out for help, it also has strained the organizations that answer those calls.

Blomme said the turnover rate among Foundation 2’s crisis counselors is nearly 50 percent. She said the difficulty is finding motivated counselors.

"It takes certain people with certain personalities and skill sets to be able to answer calls eight to 10 hours a day, (and) not knowing what may be on the other end of the call," she said. "That person has to be able to manage their own mental health because if they're not well themselves, then they can't support the people that are reaching out for help."

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Ryan Dickson, director of crisis helplines for CommUnity, said counselors are required to complete a minimum of 60 hours of training before starting, which includes 16 hours of applied suicide intervention skills training (ASIST) and attending conferences and workshops administered by the National Suicide Prevention Lifeline.

According to Iowa law, to become a crisis counselor, an individual must meet one of the following qualifications:

The law does allow for exceptions.

"If somebody interviews who has exceptional lived experience, and we feel would be a fantastic asset, we can go to the state and make our case that we want this person to work for us even though they don't meet these requirements, and then the state will make that decision," Dickson said.

He said CommUnity is in a good position to respond to 988 messages with the number of counselors on staff. To address the need for more counselors, Blomme said she will continue searching for new ways to attract potential employees.

However, she clarified that Foundation 2 will not address the high turnover rate by replacing human counselors with AI.

"The best practice is that humans are responding to humans," she said. "We use AI for various things at our organization, but we do not want AI to be addressing and trying to support someone experiencing a crisis."

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