https://www.sciencedirect.com/science/article/abs/pii/S0193953X2400025X?dgcid=author

John Draper PhD ^a

, Richard T. McKeon PhD, MPH ^baBehavioral Health Link, Inc, 7423 Narrows Avenue, Brooklyn, NY 11209, USA^bCenter for Mental Health Services, SAMHSA, 988 and Behavioral Health Crisis Coordinating Office, 5600 Fishers Ln, Rockville, MD 20852, USA

Section snippets

Key points

• •In the twentieth century, community crisis and suicide prevention efforts were not integrated into community mental health care systems. Rather, behavioral health crises were primarily managed either through public safety response systems or anonymous crisis hotlines.
• •At the beginning of the twenty-first century, the Substance Abuse and Mental Health Services Administration (SAMHSA) grant-funded the networking, certification, and evaluation of crisis hotlines. This effort led to the

Brief history of crisis and suicide prevention hotlines in the United States

Throughout the twentieth century, in the United States, custodial approaches—law enforcement and institutionalization—were the primary means for communities responding to individuals experiencing mental health and suicidal crises.^3,4 As public safety responses reinforced the long-standing stigma and discrimination associated with mental health crises, crisis hotlines began to spring up in the mid-twentieth century as an alternative means for people in crisis to seek help. A crisis service that

Substance Abuse and Mental Health Services Administration grant to network and certify crisis hotlines

In 2001, congressional funding was provided to SAMHSA to establish a national network of crisis hotlines, linked to a single toll-free number, to effectively reach and serve all persons at risk of suicide across the United States.¹² The grant administrator’s “networking and certifying” objectives included

• •Building a network infrastructure of independently operated and funded local crisis call centers in every state. Calls to a national toll-free line would be connected to providers nearest to

Lifeline evaluation findings

Perhaps the most influential requirement at the conception of the SAMHSA hotline grant was dedicating network center participation to ongoing evaluation efforts to continuously improve crisis services. In the first 20 years of the grant, 68 network centers participated in 15 studies published in peer-reviewed journals. The published works and Fig. 1 illustrate the iterative process through which Lifeline center practices are implemented, evaluated, and refined to continuously improve service

National standards and practices

Toward developing consensus approaches to actualize the 3 main recommendations emerging from the initial SAMHSA-funded hotline evaluations, the Lifeline formed in 2005 a national advisory group now referred to as the STPC. The STPC included project evaluators and other leading suicide prevention researchers, practitioners, and crisis center directors from around the country. Following are among the most prominent standards, guidelines, and practices that ultimately emerged from the ongoing

Lifeline network expansion before 988

Spurred by evaluations showing the Lifeline’s effectiveness, federal and national stakeholders continued to build on the service. In 2006, Lifeline launched a specialized service option for Spanish language callers to the service in 2006, followed by the Veteran Administration’s Veterans Crisis Line (VCL) in 2007 for current and past members of military service (“press 1”). Approximately 1 of every 4 callers to the Lifeline pressed 1 for assistance in the VCL’s first decade.¹³ Similar to the

Federal Action to Implement 988

Recognizing suicide as a major public health priority, Senator Orrin Hatch and Representative Chris Stewart of Utah introduced the National Suicide Hotline Improvement Act of 2018 with near unanimous bipartisan Congressional support. The Act required the FCC to coordinate with SAMHSA and the Department of Veterans Affairs (VA) to study the effectiveness, impact, and feasibility of establishing a 3-digit number for the National Suicide Prevention Lifeline, toward promoting immediate access to

Summary

For nearly 40 years, crisis and suicide hotlines of the twentieth century were largely viewed as services on the periphery of behavioral health care. Beginning in the twenty-first century, federal funding to network, certify, evaluate, and promote suicide hotlines facilitated greater awareness and credibility for these vital, lifesaving services. The evidence of the National Suicide Prevention Lifeline network’s effectiveness was central to the federal government assuring its greater

Clinics care points

• •Suicide risk assessments should assess for an individual’s desire for suicide (thoughts, etc.), intent for suicide (plans, preparatory behaviors, etc.), capability (past attempts, available means, etc) and buffers against suicide (reasons for living, etc.).
• •For effective crisis counseling with individuals in suicidal crisis, establishing good contact (rapport, empathy, etc.) and collaborative problem solving (safety planning, etc.) are essential to good outcomes.
• •For persons at imminent risk of

Disclosure

The content, views and opinions of the authors in this manuscript do not necessarily represent the views of Behavioral Health Link, Inc. nor the Substance Abuse and Mental Health Administration or any other branch of the U.S. Government.

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