The Creation of 988
In one important way, phone counseling is more effective than face-to-face.
Posted May 27, 2026 | Reviewed by Gary Drevitch
At one time, the prevailing opinion among many mental health professionals was that suicide hotlines wouldn’t be effective. “Several issues arise when using the telephone as the primary venue for assessing a patient’s psychological functioning,” claimed four clinicians writing jointly in the journal Suicide and Life-Threatening Behavior . “Assessing and diagnosing patients without seeing them in person deprives the clinician of important clinical information such as body language , eye contact, appearance, posture, and grooming. In addition, it is difficult to manage a crisis when large distances separate clinician and caller … Most importantly, it is difficult to develop a therapeutic relationship during a one-time telephone conversation.” [1]
That didn’t stop a small group of people from starting a suicide hotline in Los Angeles in 1962, or a onetime priest and longtime San Francisco radio correspondent for the BBC from starting a suicide hotline in San Francisco the same year. The Los Angeles hotline was launched, in part, because of all the attention around Marilyn Monroe’s death, and was answered by professionals. The San Francisco hotline, in contrast, started as a one-person affair. Acting on a hunch, Bernard Mayes placed ads on Muni buses in San Francisco saying, “Thinking of ending it all? Call Bruce,” with his phone number. Then, working under the pseudonym of Bruce, Mayes answered calls on a couch in his basement. In the beginning, he had no idea whether the phone would ring, but it did—once the first night, 10 times the first week, and 200 times the first month.
In 1998, following the postpartum suicide of his wife, H. Reese Butler founded the Kristin Brooks Hope Center and the first national suicide prevention hotline, 1-800-SUICIDE. Calls were routed to participating agencies that already answered a local, suicide hotline. Agencies weren’t reimbursed, but the cost of the line and routing service were covered by KBHC.
In 2005, responsibility for 1-800-SUICIDE and funding from the federal Substance Abuse and Mental Health Services Administration shifted to the Mental Health Association of New York City. A separate 24-hour number was created for Spanish-speaking callers.
The acronym, 1-800-SUICIDE, was easy to remember and intuitive. It also was stigmatizing. That’s why a new number was created, 1-800-273-TALK, and the service was rebranded as the National Suicide Prevention Lifeline. Calls were routed to 200 crisis centers accredited by the American Association of Suicidology, generally to the center that was closest geographically to the caller. Active-duty service members, veterans, and their families who called could press “1” to be connected to a center that had special expertise in military issues. LGBTQ callers could press “3” to be connected to the Trevor Project, a separate nonprofit organization focused on serving that population.
Calling a 10-digit number, whether 1-800-SUICIDE or 1-800-273-TALK, wasn’t optimal for people in distress, however. Suicide prevention advocates lobbied for a simple, toll-free, three-digit number analogous to 911 but for suicide. That wish was granted with the July 2022 implementation of 988 nationwide, now rechristened the 988 Suicide and Crisis Lifeline.
Counseling someone over the phone might not be as desirable as meeting with them in person, but it’s effective nonetheless—and in one way it’s more effective because clients have greater control. They don’t have to worry about offending anyone if they walk out of a session; they can simply hang up. The physical separation and anonymity also make some clients more willing to share their troubles. In addition, counseling is more accessible because it’s free, available 24-7, and clients can talk in the comfort and convenience of their home or office.
Since its inception, 988 has received more than 25 million contacts (phone, text, and chats), according to the Department of Health and Human Services. One source of controversy is that in 2025 the Trump administration terminated funding for the Press 3 option, despite the fact that youth suicide rates were 11 percent lower than projected and decreased most significantly in states with a high number of calls from young people to 988. [2] In recent Senate testimony, health secretary Robert F. Kennedy, Jr. said that the Press 3 option would be restored, but it remains to be seen whether that actually happens.
988 is funded by the federal government with some states, such as California, providing added support through phone surcharges the same way they support 911. Independent crisis centers, with trained staff and certified volunteers, answer the calls and raise additional funds from local sources to further their work.
[1] Halderman, Brent L., Eyman, James R., Kerner, Lisa, and Schlacks, Bill. “A Paradigm for the Telephonic Assessment of Suicidal Ideation,” Suicide and Life-Threatening Behavior , December 2009.
[2] Barry, Ellen. “Youth Suicides Declined After Creation of National Hotline,” New York Times , April 22, 2026.
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John Bateson was executive director of a nationally-certified crisis intervention and suicide prevention center in the San Francisco Bay Area for 16 years.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.