WEBINAR 

Current Crisis System Implementation: 

Successes and Challenges 

January 10, 2024 
Disclaimer 

The views expressed in written conference 

materials or publications and by speakers 

and moderators do not necessarily reflect 

the official policies of the Department of 

Health and Human Services, nor does the 

mention of trade names, commercial 

practices, or organizations imply 

endorsements by the U.S. government. 
Crisis Systems Response TTAC 

The Substance Abuse and Mental Health Services Administration (SAMHSA) 

has selected Altarum to provide training and technical assistance support 

to states, territories, tribal nations and organizations, and community partners 

across the 988 Suicide and Crisis Lifeline and crisis continuum of care. Along 

with our partners, W2 Consulting Corporation and Change Matrix, LLC, who 

have extensive experience with crisis services, technical assistance, and health 

equity, the Crisis Systems Response Training and Technical Assistance Center 

(TTAC) was formed to support the continued growth of 988 Lifeline and build a 

more robust crisis care system. 
Learning Objectives 

• Understand the impact of creating a crisis 

continuum of care that can meet the behavioral 

health needs of any individual in crisis. 

• Conceptualize challenges and identify solutions 

around crisis system implementation. 

• Identify resources available for crisis system 

engineering. 
SAMHSA’s 988 and Behavioral Health Crisis Coordinating Office

Jill D. Mays, M.S., LPC 

Division Director for Crisis 

System Transformation for 

the 988 & Behavioral Health 

Coordinating Office 

• Jill D. Mays is the Division Director for Crisis System Transformation for the 988 & Behavioral 

Health Crisis Coordinating Office at SAMHSA. She currently leads the evolutionary and 

collaborative work of pillars two (someone to respond) and three (a safe place for help) of the 988 

Behavioral Health Crisis Continuum. 

• Before coming to SAMHSA, Mrs. Mays served as Director of the Office of Behavioral Health 

Prevention and Federal Grants at the Georgia Department of Behavioral Health and Developmental 

Disabilities (DBHDD), where she most recently oversaw all substance misuse prevention, suicide 

prevention, mental health promotion, and behavioral health equity strategies, and served as 

principal investigator for the agency’s multimillion dollar portfolio of federal grants, including 988 and 

CCBHC grants and as planner for the mental health block grant. 

• Additionally, as Assistant Director of the Office of Adult Mental Health at DBHDD, she was the 

Project Officer for Crisis Services. Mrs. Mays previously coordinated operation of SAMHSA’s 

Disaster Distress Helpline (DDH) Core Regional Call Center in Atlanta, serving FEMA Regions III & 

IV. Mrs. Mays is a Licensed Professional Counselor, with over 30 years of experience in the 

behavioral health field and is a person with mental health lived experience. 
GUEST SPEAKER — Annette Crisp 

Annette Crisp 

RESPECT Institute 

Graduate 

Annette Crisp, is a graduate of RESPECT Institute. 

The RESPECT Institute of Georgia (RI) supports 

participants in developing the skills necessary to 

transform their experiences of mental health and 

substance use challenges and cross disabilities into 

educational and inspirational presentations. 
SAMHSA’s 988 and Behavioral Health Crisis Coordinating Office. 

Monica Johnson, M.A., LPC 

Director of the 988 & 

Behavioral Health Crisis 

Coordinating Offices 

• Monica Johnson, M.A., LPC is the Director of the 988 & Behavioral Health Crisis Coordinating Office. Ms. Johnson has worked in 

the behavioral health field for 26 years and most recently served as the Interim Commissioner for the Georgia Department of 

Behavioral Health & Developmental Disabilities (DBHDD). Prior to this role she served as the Division Director for the Division of 

Behavioral Health for eight years, the Community Mental Health Director for three years, and the Child & Adolescent Mental 

Health Director for one year. 

• Ms. Johnson’s key responsibilities during her tenure with DBHDD included leading a team of Executive Directors for the offices of 

Adult Mental Health, Addictive Diseases, Children, Young Adults & Families, Deaf Services, Recovery, Prevention & Federal 

Grants & Culture Competency, Field Operations & Crisis Coordination. Functions included managing an extensive budget of over 

$600 million dollars, development of the strategic plans for all community behavioral health programs, the development and 

oversight of policies and behavioral health practices, program development, and workforce development. Ms. Johnson is a 

seasoned executive leader with a proven track record of success. Over the last couple of decades Ms. Johnson has led the 

formation of high-profile change initiatives, chaired collaborations, and served as a board member for a variety of governing 

boards. 

• Ms. Johnson has worked in community behavioral health in a variety of clinical, management and leadership roles, including 

program development and implementation of federally funded initiatives. Ms. Johnson has overseen and successfully implemented 

several programs funded through the Substance Abuse and Mental Health Services Administration, Bureau of Justice Assistance, 

Office of Juvenile Justice Delinquency Prevention, and Department of Education. 

• Ms. Johnson earned an undergraduate degree in Psychology (minor in Communications) from Kennesaw State University and a 

graduate degree in Professional Counseling/Psychology at Argosy University. Ms. Johnson is a proud Alumnus of the Georgetown 

University Leadership Academy and a recipient of the Intensive Cognitive Behavior Therapy for Schizophrenia Certification at the 

Aaron T. Beck Institute for Cognitive Behavior Therapy in Philadelphia. 
Guest Speaker — Brian Hepburn 

Brian Hepburn, MD 

Executive Director for 

National Association of State 

Mental health Program 

Directors (NASMHPD) 

Dr. Hepburn became Executive Director of the National Association of State Mental 

Health Program Directors (NASMHPD) in July 2015. Prior to joining NASMHPD 

he served 13 years as Maryland’s Mental Health Program Director. In his role as 

Maryland SMHA Director his priorities were systems integration across a continuum of 

care in managing a Budget of approximately $1.1 billion covering: 5 hospitals, 2 

Regional Institutions for Children and Adolescents, and community services for 

approximately 155,000 individuals (45% under age 21). 

He received his M.D. from the University of Michigan School of Medicine, and received 

Residency Training in Psychiatry at the University of Maryland from 1979 to 1983. He 

was a Full-Time Faculty Member at the University of Maryland from 1983 to 1988 and 

has been on the Volunteer faculty at the University of Maryland since 1988. He 

maintained a private practice from 1983 until 2004. 

During his time at NASMHPD, he has championed the work of Beyond Beds in both 

papers and through the transformation transfer initiatives. He is extremely proud of 

the work done by states and territories particularly in the area of promoting the 

continuum of care, Suicide prevention, and 988/crisis services. 
Guest Speaker — Robert Morrison 

Robert Morrison 

Executive Director/Director of 

Legislative Affairs 

National Association of State 

alcohol and Drug Abuse 

Directors (NASADAD) 

Robert Morrison first came to the National Association of State Alcohol and 

Drug Abuse Directors (NASADAD) in 1998 when he worked on legislative and 

regulatory affairs as Public Policy Associate. Robert then served as Associate 

Director of Government Relations at Smith, Bucklin and Associates from 1999 

to 2001 where he directed government affairs programs for health care 

organizations, including the American Psychiatric Nurses Association. Robert 

returned to NASADAD in 2001 as Director of Public Policy and went on to 

become Executive Director in 2009. Robert first came to Washington in 1993 

to work for the late U.S. Senator Frank R. Lautenberg (NJ) for approximately 

four years. Robert graduated from Drew University in New Jersey with a B.A. 

in Political Science and completed graduate work in American Government at 

the Johns Hopkins University. 
GUEST SPEAKER — Annette Crisp. 
SAMHSA’s Priorities

Equity 

Trauma-Informed Informed Approaches Approaches

Commitment Commitment to Data and Evidence to Data and Evidence

Recovery 

SAMHSA’s

Priorities 

Preventing Substance 

Use and 

Overdose

Use and 

Overdose 

Promoting Resilience 

and Emotional Health 

for Children, Youth, 

and Families

Promoting Resilience 

and Emotional Health 

for Children, Youth, 

and Families 

Enhancing Access to 

Suicide Prevention 

and Mental Health 

Services

Enhancing Access to 

Suicide Prevention 

and Mental Health 

Services 

Integrating Behavioral 

and Physical

Healthcare

Integrating Behavioral 

and Physical 

Healthcare 

Strengthening the 

Behavioral Health 

Workforce

Strengthening the 

Behavioral Health 

Workforce 
The Role of SAMHSA: 

The 988 Lifeline and Behavioral Health Crisis Services Transformation 

Serve as lead federal organization 

of the 988 Suicide & Crisis Lifeline 

• Manage cooperative agreement with the 988

Lifeline network administrator

• Provide funding to help administrator, states,

territories, and tribes strengthen 988 Lifeline

services

• Align and coordinate 988 Lifeline communication

with external partners and network administrator

• Lead awareness building and behavior change

campaigns

Serve as lead federal organization 

for behavioral health crisis services 

transformation 

• Articulate long-term vision for crisis services

• Coordinate federal action within SAMHSA,

across HHS, and with federal partners

• Drive strategic partnerships with states,

territories, tribes, and external partners

• Disseminate data and quality standards

• Monitor, evaluate, and communicate

effectiveness
988 & Behavioral Health Crisis Coordinating Office 
988 Implementation & The Impact on States’ Crisis Continuums

Overview 

• Rapid development of crisis continuum 

of care 

• Role responsibility changes within 

the system 

• SAMHSA/HHS and Federal Partners 

• Vibrant Emotional Health, The 988 

Network Administrator 

• State Behavioral Health Authorities & 

Government Leaders 

• Crisis Contact Centers 
988 Grant Programs and Collaborations 

SAMHSA 

Vibrant 

Emotional 

Health 

Crisis 

Centers 

State, 

Territory, 

Tribe 

SAMHSA 

Cooperative 

Agreement 

Lifeline 

Network 

Agreement 

Contract 

(State/Territory) 

MOU (Tribe) 

SAMHSA 

Cooperative 

Agreement 

New Grants: 

• 988 State/Territory Cohort 2 

• 988 Tribal Response cohort 2 

• 988 Crisis Center Follow Up (10 cooperative 

agreements) 

• All awarded states, territories, tribes, and 

crisis centers can be found at: 

www.samhsa.gov/grants 
Snapshot of 988 Lifeline Federal Funding: 2007–2023 

0 

100 

200 

300 

400 

500 

600 

700 

800 

FY 2007 FY 2012 FY 2015 FY 2018 FY 2021 FY 2022 FY 2023 

Federal Funding to Lifeline ($, millions) 

Not exhaustive – highlights select funding years and does not include all supplemental funding awards 

$502M*** 

$152M sent to states and 

territories and $17M sent to 

tribes to build staffing across 

states’ local crisis call centers 

through grants. 

$432M** 

$2.9M $3.7M $6.2M $6.6M $23M* 

*$23M includes the President’s FY 2021 budget allocation (excludes 3–year COVID supplement of $32M) 

**$432M includes the President’s FY 2022 budget allocation of $102M, $180M from the American Rescue Plan, and $150M from the Bipartisan Safer 

Communities Act 

***$502M includes the FY 2023 Omnibus Appropriations for the Lifeline allocation of $502M and an additional $200M 

funding for states, territories, and tribes to build local capacity 
The Role of Vibrant as Network Administrator 

SAMHSA funds Vibrant Emotional Health, a national non-profit, to manage, 

enhance, and strengthen the Lifeline. The Lifeline routes individuals in the United 

States to a network of more than 200 certified crisis centers, which link to local 

emergency, mental health, and social services resources. Vibrant must maintain 

the current Lifeline infrastructure, activities, and network of crisis centers 

including, but not limited to, all telephone, chat, and text-based services. 

Challenges/Opportunities 

• Scope & Role Clarification 

• Relationship w/Crisis Contact Centers 

• Rapid internal growth 

• Navigating state government systems 

• Data Discrepancies 
States & Territories Crisis Systems Development Challenges 

Progressive/Advanced Systems 

• Mature crisis continuum in place (crisis contact center(s), an array of intensive outpatient services, crisis 

stabilization, centralized dispatch for mobile crisis, mobile crisis and co-responder teams, preferred points of entry, 

utilization of peer services, co-occurring MH/SU/IDD expertise, covers age span and specialized populations, etc.) 

• Leverages technology for coordination of the system 

• Clear provisions for expectations (e.g., standards and key performance indicators; monitoring system) 

• Clear lines of authority/accountability 

• Strong stakeholder collaborations, legislative support, and leverages multiple funding streams 

Adequate/Competent Systems 

• Fundamentals in place to leverage 988 and new funding opportunities to advance to progressive model 

• Crisis Contact Centers are experienced but may not have direct oversight by the state; less accountability 

• Has components of intensive outpatient services and crisis services but not 100% coordinated 

• Strengthening existing partnerships for innovative approaches to crisis care and has local buy in for enhanced 

funding 

Novice Systems 

• Limited to no coordinated continuum; may have parts of the service system but each part operates separately with 

limited to no accountability 

• Lack of coordination, oversight, accountability, poor relationships with contact system 

• Limited statewide crisis or intensive outpatient services and fragmented continuum 

• Lack of local support for funding and legislation 
The Role Of State Behavioral Health Authorities & Government 

• Ensure local capacity to answer 988 contacts 24/7 

• Build local capacity to ensure availability of crisis services and access to care 

• Secure funding, legislation, or appropriations for crisis services continuum 

• Lead coordination efforts between crisis contact centers, provider network, 

local stakeholders, advocacy, and federal government 

• Lead innovation efforts to advance states’ access to crisis continuum services

• Provide oversight and accountability of funding, services, outcomes, 

performance and health of the crisis network 
State 988 Legislation 

National Alliance on Mental Illness (NAMI). “988 Crisis Response 

State Legislation Map.” https://reimaginecrisis.org/map/. 
States & Territories Crisis Systems Development Challenges. 

Examples of Common Issues: 

• Data discrepancies 

• Miscommunication 

• Challenges with building complex systems within states 

• Lack of relationships between crisis contact center & state authorities 

• Authority and oversight gaps/challenges 

• Local political climates 

• Role clarity 
States & Territories Crisis Systems Development Challenges.. 

Actions/Opportunities 

• Providing educational and technical assistance support for individual states related 

to data discrepancies and other issues raised 

• Actively working on improving communication and visibility of existing mechanism 

for information exchange (grantee meeting, office hours, 988 TTAC, site visits, 

convenings, etc.) 

• Leveraging 988 TTAC for support and training for complexity with crisis 

transformation and 988 implementation challenges. (e.g., policy academies) 

• Encouraging states and contact centers to develop meaningful relationships and 

collaborations 

• Leveraging trade associations, e.g., National Association for State Mental Health 

Program Directors (NASMHPD) for communication 

• Underscoring existing mechanisms for official communication channels 
Crisis Systems Response Training and Technical Assistance Center 

988 Training and Technical Assistance Center 

Provide training and technical assistance support to federal grantees, states, territories, 

tribal nations, tribal organizations, urban Indian health organizations, crisis centers, 

behavioral health provider organizations, health systems, and first responder partners in 

the following domains: 

• Implementation of crisis services in line with the SAMHSA 2020 National Guidelines for Behavioral 

Health Crisis Care Best Practices Toolkit; 

• Utilization and integration of evidence-based and evidence-informed practices, including services that 

are culturally responsive across the lifespan and that address suicide prevention and the integration 

of mental health and substance use crisis service needs; 

• Sustainability and alignment of practices that address key drivers of crisis system advancement, 

including workforce, financing, technology, and data exchange; and 

• Applying an equity frame in the design and evaluation of crisis systems of care. 
Current Crisis System, Implementation: 

Successes and Challenges 

Brian Hepburn, M.D. 

Executive Director 

NASMHPD 

January 10, 2024 
Slide 25 

• NASMHPD 

• Beyond Beds 

• Crisis services 

• Beyond Crisis 
NASMHPD 

The National Association of State Mental Health 

Program Directors (NASMHPD) 

Represents the Public Mental Health System serving people in 

all states, territories, and the District of Columbia. 
States are Focused on Increasing Access to Community-based 

Services Including Successful 988 Implementation 

• State focus has been building robust mental health services throughout the 

continuum of care to reduce the need for beds and keep individuals served in the 

community. NASMHPD Beyond Beds papers since 2017 led by Debra Pinals MD. 

• The pandemic exacerbated the effects on mental health for all, and with the 

implementation of 988 that occurred on July 16, 2022, the need for high quality 

crisis services is at an all time high. 

• The essential elements of an effective crisis system include regional or statewide 

crisis call centers that coordinate in real-time, centrally deployed 24/7 mobile crisis, 

crisis receiving and stabilization programs including crisis beds. 

• States have turned to the SAMHSA national guidelines to expand their crisis 

systems. 
Setting the Foundation for Crisis Care 

“National Guidelines for Behavioral 

Health Crisis Care – Best Practice 

Toolkit”*

It established the “Crisis Now” model.

*Can be found on SAMHSA Website. 
State Priorities 

 988 Crisis care services/continuum 

• This includes sustainable funding opportunities and TA from federal partners on braiding 

of funds to the three parts of the crisis continuum (crisis call center, mobile crisis 

response, crisis stabilization/crisis beds). 

• Concern how MA “unwinding “ of eligibility will impact efforts. 

• IMD issue. 

 Workforce 

• Retention and recruitment efforts in states. 

• Changing system which will change workforce needed. 

• CCBHC model. Need to change from Demonstration to optional MA service. 

• Technology (Grand Lake Oklahoma iPad model) 

 Children’s Services

• Building prevention/early intervention efforts in states. NASMHPD has been advocating a 

prevention/early intervention set-aside for the Community Mental Health Services Block 

Grant (MHBG). 
State Priorities (Cont’d)

 Peer support and recovery 

• NASMHPD has been a strong advocate for peer support, and part of the current advocacy 

for the PEERS Act. Encouraging MC/MA/private payers to cover services by peers. 

 Parity 

• Health insurance coverage for mental health and substance use disorder services, when 

provided, be no more restrictive than coverage for medical/surgical services. Enforcement 

of EMTALA. 

 Telehealth 

• Use of telehealth and the use of audio-only phone calls to provide mental health and 

substance use services proved overwhelmingly beneficial during Covid. 
The Promise of 988 

• 988 will be as effective for behavioral health crisis as 911 is for physical 

health. 

• The combination of 988 and the Crisis Now (www.crisisnow.com) model of 

crisis services will connect individuals in behavioral health crisis with 

services at the level that is needed. 

• Law enforcement if safety is a concern 

• Fees provide financial stabilization for the call centers and other crisis 

services. If not fees then other funding to sustain and grow this service. 
Slide 32
Slide 33 

Thank You!! 

Brian Hepburn 

Brian.Hepburn@nasmhpd.org 
Robert Morrison 

Robert Morrison 

Executive Director/Director of Legislative Affairs 

National Association of State alcohol and Drug 

Abuse Directors (NASADAD) 
Policy Academy 2024 

Title: Crisis System Design for States/Tribes/Territories 

Objective: 

To support States, Tribes, and Territories in coalition building, role clarity, and 

application of systems engineering/design principles to develop and improve 

policies and practices in the design of Crisis Systems 
Program Components 

Preparation 

Orientation to Policy 

Academy webinar 

Two virtual technical 

assistance planning 

meetings 

Policy Academy 

2-day in-person Policy 

Academy convening in 

Tucson, AZ. 

April 1-2, 2024 

Follow-Up 

Follow-up virtual 

technical assistance 

meetings 

In-person site visit 
Policy Academy In-Person Convening 

• Select topics to be covered during the convening: 

• Systems Design 

• Funding Infrastructure 

• Embedding Equity to the Crisis System Response 

• Youth in Crisis 

• Integration of MH and SUD Crisis Response Models 

• Effective implementation of 988 

• Workforce: Development, Training, Recruitment, and Expansion 

• Team discussion to strategize and plan facilitated by a SME and consultant. 
Policy Academy Team Composition 

The Policy Academy Team should be 

representative of cross-system leaders, 

change agents, decision-makers, and 

people with lived experience. The team 

will designate a travel team of eight (8) 

members to attend the in-person Policy 

Academy. 
Policy Academy Team Composition. 

Required 

• State/Tribe/Territory Mental Health Authority 

• Single State Agency for Substance Abuse 

• State Medicaid Authority 

• Person with Lived Experience and/or Parent 

with Lived Experience of supporting Youth in 

Crisis 

• 988 Center Leadership 

• Mobile Crisis Provider 

• Behavioral Health Youth Expert 

• Community-based Organizations 

• Judicial/Law Enforcement 

Recommended 

• State Public Health Agency 

• Public Safety Answering Point (PSAP) 

• Hospital/Healthcare System 

• Public Safety (corrections/law enforcement) 

• Judicial/Law Enforcement 

• Employment/Workforce Development Agency 

• State Education Department (school-based 

mental health/suicide prevention) 

• Elected Officials/Decision Makers 

• Suicide Prevention Coordinator 

• Diversity/Equity focused representative 

• Mental Health Block Grant (MHBG) 

Coordinator 
Application Timeline 

Dec 22 – Jan 31 

Open Application 

Period 

Feb 15 

Successful applicants 

will be notified 

March 1 

Participants submit 

final Travel Team List 

April 1-2 

Policy Academy 

In-Person Convening 
How to Apply 

A complete application must include 

the following: 

1.Completed Online Application Form 

2.Completed Framework for 

State/Regional Crisis Self-Assessment 

3.Upload a team member roster with the 

application. 
Mindful Minute 
CSR TTAC Upcoming Events: 

Webinars • “Embedding Equity Across the Crisis System 

Response Continuum”

• January 31, 2024, at 1:00 pm EST. 

• “Connecting to Serve: Promising Practices for 

988/911 Collaboration”

• February 15, 2024, at 1:00 pm EST. 
This project is supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. The Crisis 

Systems Response Training & Technical Assistance Center works in conjunction with the 988 Suicide & Crisis Lifeline. In 2020, Congress designated the new 988 dialing code to be operated through the existing National Suicide Prevention Lifeline. SAMHSA sees 988 as a 

first step towards a transformed crisis care system in America. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of SAMHSA or the 988 Suicide & Crisis Lifeline. 

Contact Information 

SAMHSA’s 988 CSR TTAC

• support@988crisisttac.org 

• 844-464-8338 (toll free) 

Subscribe to the CSR-TTAC contact list to get the 

latest 988 news and invitations to our events, or 

use the QR code to the left: 

https://lp.constantcontactpages.com/sl/aUMAyq2 

Crisis Systems Response Training and Technical Assistance | SAMHSA