Autistic US Adolescents and Young Adults’ Opinions About the 988 Suicide & Crisis Lifeline: A Qualitative Analysis of an Open-Ended Survey Question

Background: The 988 Suicide & Crisis Lifeline (“988”) in the United States provides people experiencing suicidal ideation or distress with free access to trained counselors via text messaging, phone calls, or online chats. The present qualitative study investigated the following research questions: (1) What opinions are held by U.S.-based autistic adolescents and young adults ages 13-22 years old about 988; and (2) What have autistic adolescents and young adults experienced when they contacted 988 for help? Methods: Self-report online survey data were collected from English-speaking individuals ages 13-22 years old in the United States between June 2022 and October 2023 as part of a larger, parent study called Project Lift Up. Of the 295 participants who reported that they were autistic, 188 (64%) submitted a write-in response to a question about why they would or would not use 988. We used a content analysis approach to identify themes related to why they would or would not want to use 988. Results: Autistic individuals reported mixed opinions about the U.S. 988 Suicide & Crisis Lifeline. While some liked the idea of talking to a stranger or trained counselor when in crisis, others expressed anxiety about the idea that emergency services could be dispatched and questioned the preparedness of counselors to support their complex and unique needs as autistic people. Among those with direct experience with 988, some reported problems included long wait times, feeling like the counselor was using a script or interacting in a robotic way instead of authentically, and that the counselor was not able to communicate with the autistic user in a manner that felt supportive to them. Conclusions: Upgrades to 988 that will result in better crisis support for autistic people are needed, feasible, and should be evaluated.