Health

988 Has a Transparency Problem

The crisis line has provided little clarity on when and why callers in distress could face unwanted police intervention.
Katie Way
Brooklyn, US
Person calls 988 Lifeline on iPhone

Since George Floyd’s murder and the uprising that followed in June 2020, the demand by abolitionist activists and mental health advocates to remove police officers from mental health crisis intervention—especially from the response to mental health-related 911 calls and suicide hotline calls—has intensified. The federal response to those demands launched nationally on July 16: 988 Lifeline, a crisis call line designed by the Substance Abuse and Mental Health Services Administration (SAMHSA) that provides an alternative to 911 for people experiencing mental health crises, especially suicidality.

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Accessing 988 Lifeline is purposely simple—as easy as dialing or texting 9-8-8. From there, callers are routed to a trained crisis counselor local to their area code who is part of the Lifeline network. The call lines and organizations who have opted into that network all have one thing in common that caused near-immediate backlash to the initiative: Contractually, they are all obligated to call 911 under certain circumstances without informing the caller on the other side of the phone.

A representative from SAMHSA told VICE that 988 crisis counselors contacted 911 without consent for “less than half of 2 percent” of its annual callers, and only when said caller was “unwilling or unable to take actions to remain safe,” in scenarios like “active suicide attempts (overdoses, etc.) and/or stated intent to use weapons or other lethal means with the intent to cause imminent harm or death.” 

The Trevor Project’s director of advocacy and government affairs, Preston Mitchum, responded to critiques of the 988 launch in an Instagram statement that said callers do not need to share their location or any personal information with 988 crisis counselors. “For the past year, I have worked on 988,” Mitchum wrote. “I don't pretend that 988 is perfect. It is created within a system that we have yet to see. While criticism is valid, it should be honest. Yet, I have seen a lot of misinformation.”

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However, investigative reports from Mad in America found a continued practice of non-consensual call tracing by SAMHSA’s National Suicide Prevention Hotline. It is unclear if those practices have been amended with the launch of 988, and they’ve never been publicly disclosed or discussed by the agency in a caller-facing forum. SAMHSA did not directly respond to VICE’s questions about its use of geolocation surveillance to direct cops or emergency services to their callers. (Update: In a statement, a representative for SAMHSA told VICE, “988 does not currently use geolocation.”)

There are many well-publicized stories about what can happen when cops and people in mental health crises collide. Cops in Salt Lake City, Utah’s police department shot Linden Cameron, a 13-year-old child, after responding to a 911 call from Cameron’s mother in 2020; Springfield, Oregon police officers killed Stacy Kenny, a trans woman reportedly diagnosed with paranoid schizophrenia, in 2019 while she was on the phone with a 911 operator

According to a report by the Washington Post, cops shot and killed 178 people between 2019 and 2021 in response to calls for help with a mental health crisis—and that’s the number of documented cases. Yana Calou, director of public relations at Trans Lifeline, a non-profit peer and crisis hotline, said the hotline’s crisis counselors never contact 911 without explicit caller consent, which is why they are not a part of 988 Lifeline’s partner pool. Their concern is that 988 Lifeline and its partners don’t share the same policy. “I have so much respect for the people working to create this system,” they said. “I do really think it is a great opportunity to expand resources to people in need. But there are these problems with it that are really, really long-term.” 

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As part of Trans Lifeline’s #SafeHotlines campaign, launched the same day as 988 Lifeline and partially in response to an anticipated uptick in 988 Lifeline calls, the organization created a Crisis Callers’ Bill of Rights. Calou said the section around transparency is especially relevant to their concerns about 988 Lifeline: demands for “clear and upfront information about which situations hotlines use police and emergency services—to be included on websites, apps, chatbots, and greeting/hold recordings, including geotracking,” along with information about what could trigger a police/EMS response and when one has been triggered. 

“[988] is taxpayer-funded, so we should actually know what we're getting when we call, what the policies are—not have that buried on page 65 of your terms of service or privacy policy,” Calou said. (Update: Currently, 988’s “imminent risk” policies, which include police intervention, are linked on a drop-down menu on its FAQ page titled “Does Vibrant use police intervention for callers, texters, and chatters to the Lifeline?”)

At the core of those concerns is the sickening possibility that callers don’t know a call to 988 could lead to a visit from the police or emergency medical services, leading to arrest, detention, involuntary hospitalization, or worse. “People know the number for 911, and they made a different decision in the moment to call the crisis hotline,” they said. “We should be able to determine what supports and care we utilize and which ones we refuse in order to be able to protect ourselves from further harm.” 

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Calou cited the financial burden of an unexpected ambulance ride or hospital visit for an uninsured caller; the fallout from 72 hours in jail on a caller’s employment or child care situation; and the trauma and potential for injury or death during an unexpected, unwanted police encounter as possible outcomes from non-consensual crisis intervention. 

“One of the big things [for trans people] is that an involuntary psych hold in your medical history can be used by other medical providers to deny us the ability to give informed consent for life-changing trans health care, like surgery or hormones,” they said. Obviously, these aren’t intended outcomes of 988 Lifeline’s emergency intervention policy—but Calou said that a lack of consistent transparency means they remain all-too possible.

John Palmieri, acting director of SAMHSA’s 988 and Behavioral Health Crisis Coordination Office, told VICE in a statement that, of the “fewer than 2 percent of calls to the 988 Lifeline require an emergency response, most of those are done with the consent and cooperation of the caller… Those who contact the 988 Suicide & Crisis Lifeline can expect compassionate, accessible care and support for their mental health-related needs—whether that is thoughts of suicide, mental health or substance use crisis or any other kind of emotional distress.”

Still, Calou worried that the uptick in publicity around 988 Lifeline will cause the number of callers who involuntarily come into contact with cops or EMS to rise. “There's a big problem when there are Reddit forums and like Quora boards about how to call a suicide hotline and [not have the police or EMS called on you],” they said. “You're trying to offer somebody a service, and the people that you're actually trying to help are trying to figure out ways around you.” 

Correction: An earlier version of this article stated that Linden Cameron was fatally shot by police. He survived his injuries. The original story also contained an incorrect location: Stacy Kenny died in Springfield, Oregon, not Springfield, Ohio. We regret these errors. This story has been updated for accuracy and clarity.

Katie Way is a senior staff writer at VICE. Follow her on Twitter.