Understanding Factors Associated with 911 and 988 Use in Mental Health Crises.

The 988 Suicide and Crisis Lifeline was launched in July 2022 as an alternative to 911 for mental health crises. However, little is known about the factors influencing decisions to use 911 or 988 among individuals most likely to benefit from 988, including those with suicidal ideation. This study analyzes individual characteristics associated with the likelihood of calling 911 during a mental health crisis and examines awareness of, willingness to use, and concerns about 988. An anonymous online survey was conducted in early 2024 with 1,894 U.S. adults aged 18-50, oversampling racial minorities. Logistic regression models were estimated for four dichotomized outcomes: likelihood of calling 911 in a mental health crisis, awareness of 988, willingness to use 988, and concerns about 988. Independent variables included demographic characteristics, mental health indicators, perceived stigma, and financial stress. Overall, 53.9% of respondents reported they would call 911 in a mental health crisis, and 22.2% of respondents had heard of 988. After receiving basic information, 71.5% expressed willingness to use 988. However, 87.1% reported at least one concern, and individuals with suicidal ideation were much less likely to express willingness to use 988. Commonly endorsed concerns included law enforcement involvement, forced hospitalization, and service fees. Perceived stigma and financial stress were strongly associated with a higher likelihood of expressing concern. Although many individuals expressed willingness to use 988 when informed, widespread concerns may limit uptake. Our findings suggest that targeted outreach and accurate information could promote greater utilization.