In crisis and on hold: How the 988 hotline revamped callers' experience

Many people experiencing their darkest moments dial 988 for help. According to the counselors who pick up those calls, people on the other end of the line can be crying or screaming. They can be thinking about killing themselves. Or they can just need someone to listen.

But up until a few months ago, those people would often sit on hold, and the first voice they would hear wasn't coming from an actual person. Instead, it was robot-like, saying, “You have reached the 988 suicide and crisis lifeline. We are here to help.”

Then callers would hear, “Para español, oprima numero dos.” 

Followed by, “To reach the Veterans Crisis Line, if you are a US veteran or service member or are calling about one, press one.”

A pause and then, “To connect to specialized support for LGBTQ+ people under the age of 25, press three. Otherwise, please remain on the line while we route your call to a lifeline crisis counselor.”

The call had gone on now for 45 seconds. After another pause, a caller would finally be routed to a counselor. But not before hearing, “Your call may be monitored and recorded for quality assurance purposes."

This is what people seeking help heard—if they even stayed on the line long enough to be connected to a counselor—said Stephanie Grosser, technology lead for the 988 Suicide and Crisis Lifeline. She was brought on in January 2023 from the White House’s U.S. Digital Service to improve the user experience. Nine months later, she has done just that.

Under Grosser’s leadership, the agency has changed what callers hear. As a result, more than 100,000 fewer callers a year are now expected to grow frustrated by the robotic blah, blah, blah and hang up. 

Grosser made the adjustment after calling in herself and listening to what people who are despondent and possibly about to end their lives hear. She also read the feedback the crisis hotline was getting and spoke to experts. “We had a lot of complaints around the voice,” Grosser said. “How robotic it sounded. And also the music was jazz music. So people felt like it wasn't reflecting what they expected to hear when you call 988 in a crisis.”

One crucial change Grosser made was getting the administrative part of the call down from 45 seconds to 30. About 70% of the callers who hung up did so within 30 seconds. If there is one takeaway from this experience for state and local governments, she said, it’s that reducing wait times to 30 seconds or less could save lives. “What happens during the first 30 seconds on hold really matters,” she said.

For example, the intro contained “a lot of pauses,” according to Grosser. To get callers through the recording faster, “we eliminated some of those pauses.” The crisis hotline also tightened the script and found a different speaker.

Today, when someone dials 988, they hear a woman say in a soft, warm voice, “You've reached the 988 suicide and crisis lifeline. Para español, marque numero dos.”

And then, “If you’re a veteran or service member or are calling about one, press one. To connect to support for LGBTQ+ youth and young adults, press three. Otherwise, to talk with a counselor, stay on the line.” 

In another significant change, a caller is told early in the call that they can “press zero” if they don’t want to keep waiting. Grosser said this allows callers to skip hearing the recording and immediately routes the person to the local call center.

These changes have shaved 15 seconds off the call. In testing the changes, the crisis hotline has found that about 2% fewer callers are hanging up, according to Grosser. That might not seem like a huge change, but over the course of a year, it means about 114,000 more people calling in despair would actually reach a counselor. 

“We wanted to make sure that the entire experience, if you have to be on hold, is as pleasant as it could be,” Grosser said. “So that you don't want to hang up in frustration.”

Figuring out how exactly to change the caller's experience, though, took some work. 

Starting with the voice one hears when they dial 988, Grosser and her team had 17 voices to choose from. “We had a lot of different samples to work from,” she said. “A lot of research shows that people are more comfortable with a woman's voice instead of a man's voice, so we wanted to go with a woman.”

To choose the best woman’s voice, Grosser and her team listened to the samples and asked clinicians and mental health patients for their thoughts. They thought nearly all the voices sounded like they were made with artificial intelligence.

One, though, had been in an Illinois tourism ad and “just sounded like a real person,” Grosser said. “We found someone who sounded more like you're talking to a friend.”

Next, Grosser and her team took a look at the hold music. Even though the crisis hotline has gotten the recording down to 30 seconds, callers often still have to wait to be connected to a counselor. On average, the wait is another 33 seconds after the automated greeting, according to the most recent data from the Substance Abuse and Mental Health Services Administration. Some waits, though, can be longer.

What those seconds are like is also different today from what it was in January a year ago. Glosser’s team were again given several music samples to choose from—including one that sounded like disco—which they ultimately winnowed down to four. The team then asked nine people on the National Mall to listen to them. (The process was chronicled by the podcast Radiolab earlier this year.) 

Grosser’s team also examined a song written by academics and composers to reduce anxiety . “When they came in and they tested people, their heart rate went down and they were way more relaxed. We thought about contacting those people and testing that song,” she said. “But it was such a slow song that we didn't know how well it would test with the people in crisis.”

So, the crisis hotline went with the calm tinkling of a piano as its new hold music.

In addition, Grosser said they wanted people in distress to hear affirmations while they are on hold and to be told that they aren’t being forgotten.

The woman’s voice now breaks in from time to time, saying, “We are checking for a counselor who is available to talk. You'll hear music while we do this and we'll give you an update in 30 seconds.”

And then, as if a hand is reaching out, these words come out softly, "You are not alone. We care and want to support you. Someone will be with you soon.”