At one time, this was the prevailing opinion among many mental health professionals suicide Hotlines would not be effective. “A number of issues arise when using the telephone as the primary site for assessing a patient’s psychological functioning,” argued the four doctors, who co-wrote in the journal. Suicidality and life threatening behavior. “Evaluating and diagnosing patients without seeing them deprives the clinician of important clinical information, such as body languageeye contact, appearance, posture and appearance. In addition, it is difficult to manage a crisis when large distances separate the doctor and the caller… therapeutic approach during a one-time phone conversation”.(1)
That didn’t stop a small group of people from starting a suicide hotline in Los Angeles in 1962, or a priest and a San Francisco BBC radio reporter from starting a suicide hotline in San Francisco that same year. Hotline in Los Angeles partly because of all attention around the death of Marilyn Monroe, and was answered by experts. The San Francisco hotline, by contrast, began as a one-man operation. Acting on a hunch, Bernard Mayes posted ads on Muni buses in San Francisco saying, “Think it’s all over? Call Bruce” with his phone number. Then, working under the pseudonym Bruce, Mayes answered calls on a couch in his basement. At first he didn’t know if the phone would ring, but it did—once in the first night, 10 times in the first week, and 200 times in the first month.
In 1998, after after birth suicide of his wife H. Reese Butler founded the Christine Brooks Center of Hope and the first national suicide prevention hotline, 1-800-SUICID. Calls were directed to participating agencies that already answered the local suicide hotline. The agencies were not reimbursed, but the cost of the line and route service was paid by KBHC.
In 2005, responsibility for 1-800-SUICDE and funding from the federal Drug use and the Mental Health Services Administration was transferred to the New York City Mental Health Association. A separate 24-hour number has been set up for Spanish callers.
The acronym 1-800-SUICID was easy to remember and intuitive. It was also insulting. Therefore, a new number, 1-800-273-TALK, was created and the service was rebranded as the National Suicide Prevention Lifeline. Calls to 200 crisis centers accredited by the American Suicide Prevention Lifeline were generally directed to the center that was geographically closest to the caller. Active duty military members, veterans and their families who called could press “1” to be connected to a center with special expertise in military matters. LGBTQ callers can press “3” to be connected to The Trevor Project, a separate non-profit organization dedicated to serving this population.
However, calling a 10-digit number, whether 1-800-SUICDE or 1-800-273-TALK, was not convenient for people in distress. Suicide prevention advocates have lobbied for a simple, toll-free number and three numbers similar to 911, but for suicide. This wish was fulfilled with the nationwide implementation of 988 in July 2022, which now renumbers the 988 suicide and crisis line.
Counseling someone over the phone may not be as desirable as meeting them in person, but it’s effective — and in one way, more effective because clients have more control. They don’t have to worry about offending anyone if they leave the session; they can just hang up. Physical isolation and anonymity also make some clients more willing to share their problems. In addition, counseling is more affordable because it is free, available 24-7, and clients can talk in the comfort and convenience of their own home or office.
Since its inception, 988 has received more than 25 million calls (phone, text and chat), according to the Department of Health and Human Services. One source of controversy is that in 2025, the Trump administration stopped funding the Press 3 option, even though the youth suicide rate was 11 percent lower than expected and in states with the highest number of youth calls to 988.(2) In recent Senate testimony, Health Secretary Robert F. Kennedy Jr. said that Option 3 would be reinstated, but it remains to be seen whether that will actually happen.
988 is funded by the federal government with some states, such as California, providing additional assistance through phone surcharges similar to those that support 911. Independent crisis centers with trained staff and certified volunteers answer calls and raise additional funds from local sources to further their work.
