As 988 transformed crisis care, counselors balanced new rules with professional judgment

by Neil Schoenherr, Washington University in St. Louis

edited by Lisa Lock, reviewed by Andrew Zinin

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When the 988 Suicide & Crisis Lifeline launched nationwide in 2022, it brought new resources and greater standardization to crisis hotlines across the country. For counselors answering those calls, it also meant balancing new performance expectations with the needs of people in distress.

A new study from the WashU Brown School and Bursky School of Public Health published in Human Service Organizations: Management, Leadership & Governance finds that transparent management helped keep frontline 988 counselors' morale strong as new performance metrics were introduced.

At the same time, counselors relied on their clinical judgment to adapt when necessary. For example, standardized measures didn't always fit a caller's needs, so they sometimes stretched recommended call limits or adapted safety plans for people in distress.

"They weren't necessarily 'breaking rules,' but rather adapting their expertise to fit the needs of the callers they served," said Theresa Anasti, an assistant professor at the Brown School and lead author of the study.

Researchers gathered data by interviewing 28 crisis hotline workers in Missouri—seven managers and 21 frontline counselors—about their experiences following the launch of the national crisis line. The study shows how frontline workers can help shape the way new policies work in practice, particularly when standardized measures don't fully capture the complexity of crisis calls, Anasti said.

More information

Theresa Anasti et al, Street-Level Bureaucracy within Crisis Hotline Centers: Ground-Level Implementation of the Federal 988 Suicide and Crisis Lifeline, Human Service Organizations: Management, Leadership & Governance (2026). DOI: 10.1080/23303131.2026.2705584

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Psychology & Mental healthPsychiatryAllied health Provided by Washington University in St. Louis Who's behind this story?

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