Everybody Hurts

What 48 Million Messages Say About the State of Mental Health in America

In 2020, Crisis Text Line supported 843,982 texters in crisis, exchanging more than 48 million messages through 1.4 million conversations between texters and Crisis Counselors. In a year like no other, we wanted to know what issues remained prevalent and what crisis trends emerged.

Peak Anxiety

In March 2020, COVID-19 began to spread throughout the country and anxiety and stress surged, becoming the number one issue in conversations. Between lockdowns and stay-at-home orders, school and business closures, and climbing death tolls, it isn’t hard to imagine why anxiety was

top of mind for texters, and there was higher than average conversation volume almost every day after March 16. As the pandemic year rolled on, anxiety remained one of the top two issues in conversations, along with depression. Grief, eating disorders and body image issues also appeared more frequently than in 2019.

This map represents the percentage of conversations about anxiety and stress with texters from each state as categorized by a Crisis Text Line Crisis Counselor

Significant Dips in Depression and Suicidal Ideation

In a year where all of humanity was experiencing a series of traumatic events together, including racial trauma and an economic recession, conversations in which texters shared feelings of depression and sadness dropped in 2020 by 10% from 2019. Conversations in which texters expressed thoughts of suicide dropped significantly in 2020, a 20% overall decrease from the previous year. This trend was also noticeable in the relative drop in conversations flagged as “at imminent risk of suicide,” where a texter indicated they were thinking about ending their life, and they also had a plan, the means, and wanted to make an attempt within 48 hours.

While there may be several reasons for this downward trend in texters with suicidal thoughts, including an overall increase of conversations from texters, this could be a signal that suicidality dropped. In March 2021, The Journal of American Medicine (JAMA) reported that suicides in 2020 were lower than the previous three years based on information from the National Center for Health Statistics.

map of the united states showing higher rates of depression in the south east

This map represents the percentage of conversations about depression and sadness with texters from each state as categorized by a Crisis Text Line Crisis Counselor

This map represents the percentage of conversations about suicide with texters from each state as categorized by a Crisis Text Line Crisis Counselor


New Volunteers Rise Up

As the pandemic raged on, thousands of people found themselves quarantining at home, wanting to do something positive and productive. In March and April, more than 15,000 applied to become a Crisis Counselor. Through this report, volunteers across the country share why they give their time to support strangers in crisis.

National Summary

Crisis Text Line had 1.4 million conversations with texters during 2020, with higher than average volume almost every day after March 16th. We wanted to understand how mental health issues like anxiety, depression, and suicide shifted in 1.4 million crisis conversations in 2020.

Explore the trends by state

Select your state below to learn about the state of mental health across the country.

In a crisis?

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