Decreasing abandonment of calls to the 988 Suicide & Crisis Lifeline

What is the agency priority?

Strengthening crisis care and suicide prevention infrastructure – including improving the efficacy of the 988 Suicide & Crisis Lifeline (“988”) – is a high priority for SAMHSA, situated within HHS. The American Rescue Plan invested $282 million to support transition to the 988 dialing code as a replacement for the 10-digit National Suicide Prevention Lifeline.

In the four months before the study approximately 44% of calls to 988 were abandoned prior to being routed to a local call center; 11% of remaining calls were abandoned while waiting to be connected to care. SAMHSA seeks to increase the proportion of callers to 988 who connect to care.

What did we evaluate?

SAMHSA and OES, along with the national administrator of the 988 system, made changes to the integrated voice response (IVR) system and messages that callers hear when calling 988. The intervention changed the message script and voice recording during the initial IVR (before a call is routed to a local call center) and the script, voice recording, and music that callers hear while waiting to be connected to a counselor. The new IVR message callers hear before calls are routed was about 10 seconds shorter than the original IVR.

How did the evaluation work?

The program change was evaluated with a cluster randomized trial. SAMHSA and the national administrator of the 988 system deployed the updated (treatment) version of the IVR and wait messages alongside the existing (control) versions on August 3, 2023. During the 4-week study period 196,659 calls were from phone numbers randomly assigned to hear the existing version of the IVR experience and 197,130 calls were from phone numbers randomly assigned to hear the new version of the IVR experience.

What did we learn?

The updated caller experience increased the likelihood of being routed to a call center and increased the likelihood of each call being connected to a counselor. Both of these differences were statistically significant. The differences in the likelihood of connecting by phone or text within 24 hours of an initial call were positive but not statistically significantly different between the two groups.

During the four-week study period the new IVR resulted in approximately 1,400 additional calls answered by a counselor. This effect implies that if all calls to 988 are exposed to the new IVR over a 12-month period, reaching about 5.9 million calls, an additional 36,000 calls would be connected to a counselor.

Verify the upload date of our Analysis Plan on GitHub.