PHILADELPHIA — Sappho Fulton's work with people experiencing homelessness requires her to navigate the community's mental health resources every day.
But there is a year-old resource that she hadn't heard about: 988, a three-digit national mental health and suicide prevention hotline.
"If anybody needs to know about 988, it's us," said Fulton, program director of the Michael Hinson Resource Center at 17th Street and Lehigh Avenue in North Philadelphia. "We need posters all around here."
Fulton is not alone. A Pew Charitable Trusts survey found that most adults in the United States aren't aware of the hotline, even in the midst of what the U.S. Surgeon General called a youth mental health crisis and as suicide numbers threaten to reverse increases in life expectancy.
Leaders from several community organizations whose clients often express mental health concerns — Mothers in Charge, Intercultural Family Services, Ardella's House, and Philadelphia Anti-Drug/Anti-Violence Network — all told The Inquirer that they had not heard of 988.
Still, calls to Philadelphia crisis call center are rising overall, along with the number of times the city dispatches mobile crisis units to respond in the community. As 988 enters its second year, the city is looking to expand awareness and build trust.
Since the launch of 988, Philadelphia has experienced an increase in calls reporting mental health crises, according to city data. From January through May of this year, the city received 30,775 calls. That's a 7% increase from the same period before the launch of 988.
Still, nearly four out of every five calls came in through an existing 10-digit local hotline number.
Federal officials came to Philly last July to launch 988. They touted the line as a shorter, easier-to-remember version of the long-standing National Suicide Prevention Lifeline (1-800-273-TALK).
Advocates worked on its launch for years, hoping that a three-digit line would make responding to a mental health crisis as second nature as the emergency services provided by 911. Others saw in the federally driven project a potential catalyst for investment in the mental health system.
Each year in the United States, about 1.7 million suicide attempts occur and 132 people die by suicide daily, making suicide the nation's 11th leading cause of death.
Leading up to the launch, some worried that call centers throughout the nation were not ready for the increase in volume anticipated with an easier-to-dial number.
In Philadelphia, the Department of Behavioral Health and Intellectual Disability operates the Philadelphia Crisis Line, which people can reach by dialing either 988 or a local 10-digit number (215-686-4420).
"It's actually going exceedingly well," said Jill Bowen, DBHIDS commissioner.
Most calls are resolved on the phone, but the city dispatches a mobile crisis unit when face-to-face contact is needed. Such dispatches increased by roughly 30% from January to May, compared the same months in the year prior to 988′s launch.
To build trust and awareness, the city is working with the Scattergood Foundation, a Philadelphia-based mental health nonprofit, to conduct focus groups with neighborhood residents. The effort aims to tailor communications for different communities, Bowen said.
DBHIDS also created a website with information about crisis services in English, Spanish, Russian, French, Vietnamese, and Chinese.
But some still have concerns over the line, and its relationship to police.
With the launch of 988, mental health activists were worried that the line would be a pipeline for more policing, despite being advertised as an alternative to 911. "As the number of contacts rises, the number of coercive intervention rises, too," said licensed clinician Julia Lyon.
When mental health crises require more than a phone conversation, these mobile units come to help.
About one in four mobile crisis unit dispatches, or more than 100 a month, ends with an involuntary commitment, according to DBHIDS data.
Still, Lyon said that it's positive that people can both call and text 988.
"Sometimes people have resistance to speaking on the phone," she said. "You can imagine if they are in a violent or abusive situation or have limited privacy they can't have 10-minute phone calls."
Jasper Liem, executive director of the Attic Youth Center, a support resource for LGBTQ youth, said some youth preferred his organization's counseling service. They weren't sure how they would be treated by 988 operators, and feared a call would result in involuntary hospitalization.
"Our youth know about the number, but do not have enough trust to use it," he said.
