From hotline to helpline: The impact of audience research to increase willingness to seek help through the 988 helpline

Theoretical Background and research questions/hypothesis:

There is a growing mental health crisis in this country, with a CDC-reported increase in suicide rates in 2021 after two years of declines in 2020 and 2019. As part of the effort to address this crisis, in summer 2022 the National Suicide Hotline Designation Act, signed into law, which transitioned the 10-digit National Suicide Prevention Lifeline to 988 as a new three-digit number for suicide and mental health crisis. Research was conducted to inform a campaign to increase awareness and usage of the 988 services among residents in Central Maryland.

Methods:

75-minute in-depth interviews (n=60) were conducted with residents in the Greater Baltimore area (Baltimore City n=15, Baltimore County n=15, Carroll County n=15 and Howard County n=15). Participants were recruited to achieve diversity in educational attainment, race/ethnicity, household income levels and lived experience with mental health and substance use. Interviews consisted of language testing with various message frames and visual testing with sample images and brand concepts.

Results:

This audience research revealed essential insight into developing communications messaging to Central Maryland residents. We found that certain words or phrases common to the mental health and suicide prevention space, such as “crisis,” ‘hotline,” “crisis line,” “struggle,” made participants less likely to call, as those phrases evoked a situation that’s out of their control, and did not resonate with people not in active crisis. These common phrases were associated with urgent “life or death” scenarios, which made them feel like calling 988 wasn’t something they would do because their issues didn’t rise to the level of “crisis.” This cognitive barrier would prevent people from seeking more preventative support ahead of reaching an urgent breaking point. These insights emphasize the importance of conducting message testing with audiences and using language that helps meet them where they are.

Conclusions:

Findings were used to develop a campaign brand (CALL 988), messaging for a website, campaign materials, and toolkit resources for local community partners. The CALL 988 campaign’s asset-based approach to messaging has been praised by SAMHSA. Our ads have received millions of impressions, and received positive resident feedback, with some commenting on the ads to share their own stories or sentiments of support.

Implications for research and/or practice:

Findings from this research provide a framework for talking about mental health services in a way that destigmatizes and decreases emotional barriers to help-seeking. Presentation will include description of methodology and approach to designing message frames that isolate tone and behavioral determinants, as well as full findings on language that resonated with participants and increased willingness to call 988.