Bipolar Me

The 988 Helpline and Option 3

The 988 crisis helpline has been in place since July 2022, and most people consider it a success. 988 specializes in behavioral health crises and offers crisis counseling and emotional de-escalation, unlike the older 911 hotline, which focuses on problems requiring police, fire, and EMS.

“Nearly 4,400 fewer U.S. teens and young adults died by suicide than projected in the first two-and-a-half years of the 988 mental health crisis hotline, a sign the program is working even as it faces long-term funding challenges,” according to the Associated Press.

Those “long-term funding challenges” arise from the way the helpline gets its money. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) provides primary funding for the overarching national network, and they administer the helpline’s operations. Then, the National Suicide Hotline Designation Act of 2020 allows states to pass legislation assessing a small, monthly surcharge on phone and VoIP lines to sustainably fund local crisis call centers. Dozens of states have adopted this model. In states without phone surcharges, local call centers rely on general state budget appropriations, mental health block grants, Medicaid billing, and private donations.

If that system sounds cobbled-together and potentially rickety, well, it is. Aside from the SAMHSA funding, how much your local helpline gets to stay in business is far from guaranteed.

Recently, there was a decision that could put an end to one of the important aspects of 988—Option 3. When callers select Option 3 from the menu, they are connected to a portion of the helpline specifically designed to handle LGBTQ+ callers. Because the LGBTQ+ community accounts for a significant number of suicides, cutting off this kind of help would have been a tragedy that would have led to other tragedies.

It almost happened.

On July 17, 2025, a press release reported, “Today, the 988 LGBTQ+ crisis support line is being shut down as previously ordered by the Trump Administration. In response, a bipartisan group of federal lawmakers and national mental health advocates spoke out against the harmful decision and called for its immediate reversal. Today’s event follows an earlier plea to U.S. Department of Health and Human Services Secretary Robert F. Kennedy, Jr., urging his office to ‘scrap this ill-advised plan.'” The release continued, “Its closure comes at a time of growing need — just last year, nearly 40 percent of LGBTQ+ youth seriously considered suicide, according to national surveys.”

Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness (NAMI), speaking about the absence of Option 3, said that “we lost the trust of a lot of people who no longer saw themselves as being reflected in 988.”

SAMHSA tried to calm the situation: “Everyone who contacts the 988 Lifeline will continue to receive access to skilled, caring, culturally competent crisis counselors who can help with suicidal, substance misuse, or mental health crises, or any other kind of emotional distress.” And The Trevor Project tried to pick up the slack, though it has nowhere near the bandwidth to mount a thorough campaign and serve all those needing help.

Then, on April 24, 2026, a reprieve came. MedPage News reported, “Advocates for the LGBTQ+ community claimed a win this week after the Trump administration pledged to reinstate the 988 Suicide and Crisis Lifeline specialized support program tailored to their needs.”

The report continued, “During a Senate hearing earlier this week, HHS Secretary Robert F. Kennedy Jr. was asked whether he would commit to restoring the tailored line for LGBTQ+ callers to 988, as required by law, after the Trump administration removed it last summer.”

Kennedy, with no apparent sense of irony, was reported as saying, “We are working on getting it up now.”

Chase Anderson, MD, of the University of California, San Francisco, said that while reinstating the specialized 988 line option is a “nice step,” he remains skeptical due to the continued attacks on LGBTQ+ individuals, especially transgender people, by the Trump administration and the Supreme Court.

MedPage Today notes, “The fiscal year 2026 funding bill included $535 million for the 988 Suicide and Crisis Lifeline, including $33.1 million for the LGBTQ+ line. The legislation does not include a timeline for reinstating the program.”

If I hear any more about this issue, I’ll let you know.