If you’re in immediate danger, call 911. If you’re having thoughts of ending your life, or are in crisis and not in immediate physical danger, call or text 988 — the Suicide and Crisis Lifeline, free, confidential, 24 hours a day, with Spanish-language and other services available.
Everything below is context for choosing between them.
988
Call, text, or chat. Staffed by trained counsellors, not police. The overwhelming majority of contacts are resolved on the call itself without any emergency service involvement — this is the single most common misconception and the reason people don’t call.
You don’t have to be suicidal. It’s for crisis of any kind, including for people worried about someone else. There’s a dedicated Veterans Crisis Line (press 1) and specific support for LGBTQ+ young people (press 3).
Crisis Text Line
Text HOME to 741741. For people who can’t speak on a phone, which is a large group and includes a lot of people in shared housing.
San Francisco street crisis response
San Francisco operates teams that respond to people in psychiatric or substance-related crisis in public, as an alternative to a police response. They’re reached through 911 and through 311.
If you’re calling about someone on the street, say clearly that it’s a behavioural health crisis and that you’re asking for the crisis response team. That framing changes what gets dispatched, and it’s worth knowing before you’re standing there.
The county access line
San Francisco’s behavioural health services operate an access line for assessment, referral and urgent care — the correct first call for someone who needs services rather than an emergency response, and the route into county-funded treatment regardless of ability to pay. More on that system here.
What actually happens if you call 988
The fear that keeps people from calling is that they will be sectioned, or that police will arrive. Worth addressing directly.
A counsellor answers, asks what is going on, and talks with you. Most calls end there. Emergency services are involved only where there’s imminent risk to life and the situation can’t be resolved on the call. Involuntary holds in California — the 5150 — require a specific legal standard, and expressing distress or suicidal thoughts doesn’t meet it on its own.
Telling a clinician you’re having suicidal thoughts is likewise not, by itself, grounds for hospitalisation. Clinicians ask about plan, intent and means, and thoughts without those are extremely common and get talked about rather than acted on.
Other specific lines
National Domestic Violence Hotline: 1-800-799-7233, or text START to 88788. RAINN, for sexual assault: 1-800-656-4673. Trevor Project, for LGBTQ+ young people: 1-866-488-7386. Trans Lifeline: 1-877-565-8860, which has a policy of not calling emergency services without consent. SAMHSA National Helpline, for substance use: 1-800-662-4357.
Before you need it
Put 988 in your phone now. Tell one person that you would contact them. And if you’re in treatment, ask your clinician what to do outside hours — that answer differs by practice and is much easier to get on a calm Tuesday than at eleven on a Saturday night.