HHS Eliminates LGBTQ+ Specialized Services for the 988 Suicide & Crisis Lifeline: What Does This Mean for Mental Health Care Specialists?
The Substance Abuse and Mental Health Services Administration, an agency within the HHS, officially ended the 988 Suicide Prevention & Crisis Lifeline's LGBTQ+ youth–specific “Press 3” option effective July 17, 2025, following the release of HHS's 2026 budget proposal.
The 988 Suicide Prevention & Crisis Lifeline was first launched July 16, 2022, and introduced a subnetwork for specialized services for LGBTQ+ individuals shortly after the launch.
In this expert Q&A, Margie Balfour, MD, PhD, discusses what this decision could mean for LGBTQ+ mental health care and the consequences this could have on clinical practice. Dr. Balfour is the chief of quality and clinical innovation at Connections Health Solutions and associate professor of psychiatry at the University of Arizona in Tucson, AZ.
Additional Resources:
- HHS FY 2026 Budget in Brief. https://www.hhs.gov/about/budget/fy2026/index.html. Published June 11, 2025. Accessed June 11, 2025.
- Internal budget document reveals extent of Trump’s proposed health cuts. https://www.washingtonpost.com/health/2025/04/16/hhs-budget-cut-trump/. Published April 16, 2025. Accessed June 11, 2025.
- SAMHSA Statement on 988 Press 3 Option. https://www.samhsa.gov/about/news-announcements/statements/2025/samhsa-statement-988-press-3-option. Published June 17, 2025. Accessed June 17, 2025.
- Balfour M. Update: overcoming challenges in launching 988 mental health hotline [podcast]. Consultant360; March 15, 2023. https://www.consultant360.com/podcasts/update-overcoming-challenges-launching-988-mental-health-hotline
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Consultant360: Can you describe the role and importance of specialized LGBTQ+ services in the broader mental health landscape?
Dr. Margie Balfour: People who are LGBTQ+ are at extraordinarily high risk for suicide compared to their peers. They're four times as likely to attempt suicide and one LGBT youth attempts suicide every 45 seconds according to the latest data. Having services that are specifically targeted to this population that involve people who are trained counselors who either have a shared experience that they can help engage with that person or are well-versed in the types of stressors that are leading to these youth to attempt suicide are an extremely important part of suicide prevention.
Consultant360: How did the specialized lifeline offer support to LGBTQ+ individuals differently than a general crisis hotline?
Dr Balfour: So the people who are on the other end, on the other end of either the calls or 988 can also do text and chat, the people on the other end are specifically trained in working with this population and understanding the stressors that are involved that put them at higher risk. It's not anything about being inherently gay or transgender that create the suicide risk. A lot of it is the social stressors that they experience because of their sexual orientation in our society. These youth, about a third of them report that they've not been accepted by their parents, another third report that they don't disclose their status until they're adults, so just not having that acceptance and not having an environment that allows them to exist without the fear of rejection. They're more likely to be bullied also by their peers. So all of those contribute to their suicide risk. And so having someone on the other end of the line that understands that is hugely important to doing the interventions that are going to help with that person to help them get the help that they need, help them feel comfortable to discuss what's going on and feel comfortable enough to work on a safety plan and getting them into the care that's going to help them.
Consultant360: In your professional opinion, what will be the impact of this decision?
Dr Balfour: One piece of it is that when you call 988, you won't have that immediate route to connecting to that specialized resource, and that's one of the reasons why 988 was such a big deal, is that instead of having to know all these different hotlines, you can just remember one number: 988. That access would be cut off and then the funding that goes along with 988 has really helped to expand the services of these specialized hotlines. So, for example, the Trevor project was existing before 988 and they do a lot of the calls that come through 988 that go to that LGBTQ subnet, but they've gotten a lot of funding to increase their capacity. I think the subnet receives upwards of 100,000 contacts a month. So that's a lot of resources and the crisis lines like the Trevor Project, they'll still continue to exist if the funding gets cut, but you don't have the funding to continue with that high capacity that you know one of the success stories of 988 is that it has opened up access and that they are getting many more contacts.
Consultant360: What does this mean for practicing mental health specialists?
Dr Balfour: Yeah, mental health specialists who are treating LGBTQ youth need to be aware that this resource is going away. It's something that many of us when we're working with people who are at risk, we tell them about things like 988 that they can reach out to. I think they're going to need to kind of go back to the way it was before 2022, before we had 988, and make sure that they have those resources for those specific crisis lines that they can access directly.
Consultant360: What are some of those other resources that they can look for?
Dr Balfour: The main one is the Trevor Project, and they have a wonderful website. If you go to thetreverproject.org, there's buttons for you to immediately create a call or create a text or a chat.
Consultant360: How can clinicians advocate for specialized LGBTQ+ services in this current climate?
Dr Balfour: I think as clinicians, I try to stick to the science. There's a lot of rhetoric going around, around cutting services and should services be funded for specific populations. When it comes down to it, the lifeline is about saving lives. I mean, that's why it's called the lifeline and it's just a basic tenet of medical science that when you have a population that's identified to be at high risk for some negative outcome regardless of what it is and regardless of who the population is, you target services to address that population because your purpose is to prevent death and to save lives. The LGBTQ youth population is an extraordinarily high risk to die by suicide, four times more likely to attempt suicide than their peers, one attempt every 45 seconds. It's not about DEI, it's not about being woke, it's about saving lives and getting resources to the populations that are at highest risk.