Woodsy Owl, an environmental icon launched by the United States Forest Service, told school children, “Give a Hoot! Don’t Pollute.” Smokey Bear, part of another U.S.F.S. campaign, increased the public’s awareness of fire prevention, helping reduce annual wildfires by more than 40,000 between the 1930s and 1950s. Of course, perceptions and behaviors didn’t change overnight, but the campaigns were strategic, targeted, and, in the end, successful. “A good national marketing strategy permeates public consciousness,” said Meena Dayak, practice director at McKinley Advisors and RI International board member. “We need that in mental health.”
In May 2019, John Draper, former director of the National Suicide Prevention Lifeline (now called the 988 Suicide and Crisis Lifeline), told #CrisisTalk he hoped a three-digit number for mental health and suicide crisis would one day be as ubiquitous as 911. His daughter, who has struggled with anxiety and depression, told him people would finally understand mental health crises are real and require a different response than police or emergency medical services. She said the cultural shift “would likely do more than anything else to erase stigma against mental illness….”
Dayak emphasized marketing is the conduit for Draper and his daughter’s hopes to become a reality by helping maximize the potential of 988. “It can increase the public’s knowledge of the 988 number and general awareness of mental health,” she said. What it will take, though, is a multi-pronged marketing effort, starting with a national-level campaign to give the general population information on what to do if they or someone else is experiencing a mental health emergency. “We need that national Super Bowl commercial and celebrity endorsement, so 988 is on everyone’s radar—because you never know who needs it.”
A statewide Super Bowl ad on 988 ran in Oklahoma called “Get the burden off your back.” In it, Broadway and television star Kristin Chenoweth, who has been open about her own mental health struggles, is the personification of a man’s anxiety and negative talk—quite literally on the man’s back as she sings each of his concerns out loud: “Everyone knows you cry yourself to sleep” and “Oh! She’s never gonna love you like she loves that phone!” Finally, his spouse asks the man, “Honey, do you need to speak to someone about ‘the Kristin Chenoweth’ in the room?” The man says, “Yes.” The voiceover states: “We all have our burdens. Call or text 988 to get yours off your back.”
Financially supported and strategic national public awareness campaigns cascade to states and localities. Dayak said that starting at the state or local level would be a mistake because many places are already strapped for funds and using what they have to get their 988 system up and running. “They also can’t gain the same kind of visibility and traction that a strategic national campaign can.” That said, some states will be ready to launch 988 marketing ahead of the nation, creating an ideal opportunity to roll out the national marketing campaign first. “This allows us to test the campaign in select markets, and, in turn, they can share best practices and lessons learned.”
Dayak also believes grassroots efforts are critical to the success of 988. “Besides a well-funded national campaign, we need segmented campaigns, influencer marketing, and peer support advocates and champions.”
The ALS Ice Bucket Challenge in the summer of 2014 highlights the power of organic, grassroots efforts. In July 2014, pro golfer Chris Kennedy challenged his wife’s cousin, Jeanette Senerchia, to do the ice bucket challenge and bring awareness to Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease). Senerchia’s husband had the disease. She shared the challenge on her Facebook page, helping spread the effort from New York to Boston and across the U.S., with Jimmy Fallon, Derek Jeter, Leonardo DiCaprio, Mark Zuckerberg, Bill Gates, and David Spade getting involved. The focused campaign helped raise over $115 million for the ALS Association and funded a new drug the FDA approved in 2022.
Dayak also suggests partnering with healthcare providers like primary care physicians. Doctors often have an after-hours recording, prompting callers to dial 911 if they’re experiencing a medical emergency. However, contacting the 911 crisis system can be lethal for marginalized populations, especially Black people and those in a mental health crisis, who make up 27% and 21% of people killed in the U.S. by a police officer in the line of duty since January 1, 2015. “These recordings should state that if the person is in a mental health emergency to please hang up and call or text 988,” she said.
Marketing 988 has been a matter of ongoing debate, with leaders trying to balance ensuring all Americans have access to 988 and that 988 crisis systems can help all people who need it. “We don’t want to underutilize 988, and we don’t want our marketing to push the crisis system beyond what it can accommodate,” Dayak emphasized. “They need to grow together.” The Substance Abuse and Mental Health Services Administration has created a publicly accessible 988 partner toolkit, including communication outreach materials such as the 988 logo, branding, PSA scripts, presentation decks, and shareable social media content.
How to gauge when and where to expand 988 marketing must be data-driven, monitoring and analyzing data from the entire crisis continuum, said Dayak. One metric is a state’s 988 contact center answer rate. However, the 988 crisis system isn’t just the 988 Lifeline contact centers but also mobile crisis and 23-hour receiving and crisis stabilization facilities. “We want to expand marketing when we know the 988 infrastructure can adequately match people with the needed resources, like a mobile crisis team dispatch.” If those pieces are in place and coordinated, it’s time to turn up the dial on marketing 988.
The National Association of State Mental Health Program Directors Research Institute (NRI) is tracking State Mental Health Agency 988 initiatives, including 988 contact centers, mobile crisis teams, and crisis receiving and stabilization facilities. As of December, 19 states have a crisis system data dashboard that tracks and analyzes performance metrics. Also, some states have publicly accessible 988 contact center dashboards, like Solari in Arizona. The public-facing dashboard shares many metrics, including answer speed, volume, trends, referral sources, the top areas served, and primary reasons for calling. (As of October 2022, the top five reasons to contact the line were coordination of care, self-harm/suicidal, social concerns, substance use, and aggressive/danger to others.) It also has a pie chart that monitors what happens after people call the crisis response network—like how many calls the network stabilizes and how many result in crisis transport dispatch.
However, NRI has found that most states aren’t collecting data across the crisis continuum. For example, 2021 data collected from participating states showed that only 35% of interviewed state behavioral health authorities track data from their crisis stabilization facilities. The benefit of collecting data on all parts of the crisis system is that it identifies where there are missing pieces, lack of care coordination, and whether people are matched with the care they need when they need it, said Dayak.
Utah’s public-facing dashboards track 988 contacts and other vital metrics throughout the behavioral health continuum, like the state’s mobile crisis services response, receiving center services, early intervention, and recovery support. (In February, the top five reasons for contacting the crisis line were situational stress, suicidal ideation, information only, coordination of care, and psychosis or grave disability concern.) The state collects comprehensive receiving center metrics, including insurance type, age, race, ethnicity, and who brought the client to the center, such as the client themselves, a family member or friend, or a law enforcement officer. It also includes primary presenting concerns and outcomes, whether clients went home or to a residential treatment facility, homeless shelter, the hospital, or a 23-hour crisis stabilization facility.
Some states like New York included developing metrics to track the 988 crisis system in their 988 legislation—not just answer rates but also 988 volume, wait times, and information on callers who receive a mobile crisis response or go to crisis receiving and stabilization centers. Metrics and data feedback loops will help identify system gaps and disparities, said Hannah Wesolowski, chief advocacy officer of the National Alliance on Mental Illness. “We need to know if 988 diverts people from the criminal justice system and if that varies by race, socioeconomic factors, or geography. It’s important that there’s accountability from the onset.”
The data feedback loops will also help states determine when and how to expand their marketing, said Dayak. That includes a look at diversion from 911 and referral sources to the 988 contact centers, such as whether there’s an increase in third-party callers. According to the publicly available data in Utah and Arizona (contacts answered by Solari), people seem to be primarily contacting the lines for themselves. Diversion from 911 is critical and life-saving; it will also increase 988 volume. In addition, third-party callers can be trickier because people share their perception of another person’s experience, which their own experiences and biases can shape.
Dayak noted some 988 systems might be able to support most people but continue failing to reach marginalized populations. “Communities must invest in targeted and segmented campaigns and partnerships to reach them,” she explained. That means including people from those groups in decision-making. “For example, you need young people to reach other young people.”
Marketing 988 requires not only data collection and feedback loops across the entire crisis continuum but also federal, state, regional, and local public-private partnerships. “That’s the optimal way to ensure 988 marketing scales and is in sync with the 988 crisis systems,” she said. However, that takes funding. Just as bipartisan support and partnership across intersecting systems have made 988 a reality, the same is needed for marketing 988. “Now we need to come together to invest in this massive awareness campaign,” said Dayak. “Let’s invest in saving lives. Let’s invest in marketing 988.”