By Rochelle Hamilton
It feels like just yesterday that I was enjoying a cup of coffee in my office at the elders’ department of a local tribe when I received an email from my sister: “Rochelle, we need to talk. Come work with me.”
“No thanks, I’m happy here.” I replied. At that time, I genuinely loved my role in the tribal elders’ department and couldn’t imagine a more fulfilling position. Still, it was heartening to know that my sister believed in my skills!
Before long, she visited my office for a quick meeting about her work with the Washington Indian Behavioral Health Hub. We exchanged resources to support our respective programs. During our conversation, she mentioned job opportunities at her organization and thought I’d be a great fit. Again, I politely declined, saying, “No thanks.”
Then she presented a piece of paper outlining the job description. Curious, I asked, “What is 988? This sounds important.” She explained that her organization was launching a crisis call line specifically for Native people, funded through recent legislation.
In that moment, I recognized the significance of this initiative. It was an opportunity I couldn’t pass up. “I’ll apply,” I said. “This really matters.” Just a few months later, on November 10, 2022, the Native and Strong Lifeline was launched—the first tribal 988 line in the United States.
What is 988?
To understand the importance of tribal 988, it helps to understand the origin of the 988 Lifeline and its evolution. Although 988 is a new, nationwide number, it is not a completely new program or concept. The 988 Lifeline, originally known as the National Suicide Prevention Hotline, launched January 1, 2005, with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA). The original hotline operated as an 800 number for several years, but it was decided that the number should be replaced with a shorter, easier-to-remember option for those in crisis.
Today, we are fortunate to only have to remember a few short digits: 988
When you hear “988,” you might think, “That’s for someone else, not me.” But 988 is designed for everyone. We all face crises, even if they come in different forms. What feels like a crisis to one person might seem like a minor inconvenience to another, but every challenge is valid.
Reasons People Call 988
Here are some reasons people have called 988:
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Every reason for reaching out is valid, and every caller deserves to be heard and supported.
What to Expect When You Call 988
Recently, I called 988 to ensure I could provide my friends and family with accurate information. When you call, you will hear an automated greeting and can press “0” to connect directly with a crisis counselor. They’ll greet you warmly and ask how they can help.
If you prefer specialized care, you can choose options tailored to your needs: Veterans can press 1, Spanish speakers can press 2, and those seeking LGBTQ+ support can press 3. In Washington state, you can press 4 to connect with a Native crisis counselor at the Native and Strong Lifeline, which is staffed by trained Native counselors ready to listen and provide support.
Washington state’s culturally grounded tribal 988 service (reached by pressing 4) is an innovative initiative. It is being closely studied across Indian Country as a model for addressing unique cultural needs while providing crucial, lifesaving support.
For those who may not feel comfortable with a phone call, texting or chatting with 988 is also available. This option is particularly beneficial for anyone who might feel anxious speaking on the phone, as the text service connects you with a real person—no automated responses here.
The Need for a Tribal 988
While 988 serves everyone, vulnerable populations (such as Native people) have unique needs that must be considered. Data shows that Native American and Alaska Native individuals are experiencing worrisome suicide rates—higher than any other racial or ethnic group in the U.S. (Stone, Trinh, Zhou, et al., 2022). As states and public health entities seek to support suicide prevention efforts in Native communities, establishing a tribal 988 line is a crucial first step.
Tribal 988 offers a dedicated line that provides specialized care for those most affected by suicide. Staffed by individuals who share similar cultural backgrounds, tribal 988 doesn’t require additional training in cultural humility; it is inherently culturally informed.
Have you ever struggled to find a comprehensive list of Native American behavioral health providers? You’re not alone. Imagine the comfort of receiving care from someone who understands your experiences and the nuances of your cultural identity without needing constant explanations.
The Unique Impact of the Native and Strong Lifeline
Washington state’s Native and Strong Lifeline is the first tribal 988 in the country, and it should not be the last. Importantly, an all-Native team of professionals staffs the line. This includes crisis counselors, shift leads, coordinators, managers, and directors. In fact, more than 25 Native American professionals lead the program, and it continues to grow.
At the Native and Strong Lifeline, they understand something Native American people have always known to be true: That culture and connection are prevention and that culturally affirming support can help to heal.
Many Native individuals are understandably hesitant to seek help from non-Native providers. No doubt, all behavioral health care providers want what is best for us and are well-intentioned, but sometimes what is best for us is … us. Sometimes, what we need most is support from our own community.
Expanding Access to Specialized Care
A question that I often hear in the 988 world is: “If Native American populations get their own 988 line, won’t everyone else want their own too?”
Of course– and many populations already do! In fact, the first 3 options on the 988 menu are for veterans, Spanish speakers, and the LGBTQ+ community. These populations are also in need of specialized care, and fortunately, they have it. Unfortunately, Native Americans are not yet a part of that menu outside of Washington state.
We need to change that; and now we know how.
Moreover, the government-to-government relationship between tribes and the U.S. government is unique, based on a trust responsibility, and requires special consideration. Many states and governments would like to strengthen and build upon this government-to-government relationship through collaborative efforts and meaningful partnerships.
As we reflect on this information, it is clear that establishing a dedicated tribal 988 line within the broader 988 system is not only beneficial but also essential. Imagine the positive impact on Native communities for generations to come. We as a country have the opportunity to implement 988 equitably from the start, rather than looking back years from now and saying, “We should have done something better for our most vulnerable relatives.”
The time is now. The opportunity is now. The future is now. Why wait?
Stay Tuned!
In my next post, I’ll explore Small Strides, Big Results: Tribal Engagement in the 988 World.
Reference
Stone D, Trinh E, Zhou H, et al. Suicides Among American Indian or Alaska Native Persons — National Violent Death Reporting System, United States, 2015–2020. MMWR Morb Mortal Wkly Rep 2022;71:1161–1168. DOI: http://dx.doi.org/10.15585/mmwr.mm7137a1
Rochelle Hamilton is a Tribal 988 Advisor for KAI. She previously served as the director for Washington State’s Native and Strong Lifeline, the nation’s first 988 crisis line designed by and for Indigenous people.
