Answering The Call

The introduction of 988 in July 2022 represents an unprecedented opportunity to ensure that the growing number of Americans needing mental health services receive the care they require. It also provides an opportunity to ensure that the nation’s existing emergency response infrastructure is ready to help direct individuals to the proper care.

Rates of mental illness and suicide in the United States are high and rising and are particularly pronounced among young adults and residents in rural areas. With appropriate coordination, training, and financial support—including utilizing existing resources—the nation’s emergency infrastructure can better help more Americans needing behavioral health crisis care. This is especially true for those individuals who are in a suicidal crisis. The new number to the National Suicide Prevention Lifeline, 988, will provide an alternate access point into care and help keep individuals in crisis from needlessly cycling through emergency departments (EDs) and the criminal justice system.

Congress recently made historic levels of investment in behavioral health care and 988, including a $77 million increase for the National Suicide Prevention Lifeline. President Biden’s fiscal year 2023 budget also proposed investing in behavioral health services, including funding to implement 988 and build out the U.S. crisis system. As such, the recommendations in this report focus on enhancing federal support for the effective and equitable buildout of 988 alongside existing crisis response infrastructure while primarily utilizing existing resources.

This report provides insights into three areas essential to the implementation of 988 and the broader crisis response continuum: interagency collaboration, the behavioral health workforce, and financing.

Collaboration between agencies and with states is critical for ensuring that they help providers deliver behavioral health crisis services equitably and effectively. Because behavioral health crisis systems rely on state-level action, the federal government must both support states and strive to maintain interagency coordination. Up to this point, state and local governments have received only limited federal guidance on how to effectively implement and utilize crisis response services across the continuum of care. The federal government should establish federal standards for a coordinated state and local crisis response beyond the 988 call centers.

A well-trained behavioral health care workforce is equally critical to the success of 988. As such, Congress and the administration should make investments to increase, train, and sustain the behavioral health crisis response workforce to ensure that sites across the continuum are adequately staffed to meet the needs of the communities they serve.

Last, Congress should sustainably finance a nationwide crisis response infrastructure to ensure that all Americans have access to the appropriate resources in their time of need. This report identifies areas of near-term federal support and guidance that would prove valuable; however, the success of 988 will require ongoing efforts evaluating the resources needed to support the behavioral health continuum in the long-term should Congress reduce funding. Additionally, there are areas in which guidance from the Centers for Medicare and Medicaid Services (CMS) would help to make the most of existing resources for coverage of services across the continuum of care.

Over the past year, BPC conducted dozens of interviews with experts and policy leaders—including state Medicaid experts, peer support specialists, hospital administrators, and EMS professionals—to develop recommendations for a comprehensive crisis response system. Although this system stands to benefit all Americans, there are unique considerations that pertain to children and adolescent mental health that fall outside this report’s scope.