0 

Snapshot of Behavioral Health Crisis 

Services and Related Technical 

Assistance Needs Across the U.S.

FINAL – May 8, 2023 

Prepared under the Substance Abuse and Mental Health Services Administration

Center for Mental Health Services/Center for Substance Abuse Treatment

State Program Improvement Technical Assistance Project

Contract/Task Order No. HHSS283201700019I_75S20322F42003 (Ref. No. 283‐17-1903) 
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Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

FINAL 

Acknowledgements 

This report was prepared for the Substance Abuse and Mental Health Services Administration 

(SAMHSA) under contract number HHSS283201700019I_75S20322F42003 (Ref. No. 283‐17-1903) 

with SAMHSA, U.S. Department of Health and Human Services (HHS). Michelle Gleason served as 

contracting officer representative. 

Disclaimer 

The views, opinions, and content of this publication are those of the author and do not necessarily reflect 

the views, opinions, or policies of SAMHSA. Nothing in this document constitutes a direct or indirect 

endorsement by SAMHSA of any non-federal entity’s products, services, or policies. 

Public Domain Notice 

All material appearing in this publication is in the public domain and may be reproduced or copied 

without permission from SAMHSA. Citation of the source is appreciated. However, this publication may 

not be reproduced or distributed for a fee without the specific, written authorization of the Office of 

Communications, SAMHSA, HHS. 

Recommended Citation 

Substance Abuse and Mental Health Services Administration: Snapshot of Behavioral Health Crisis 

Services and Related Technical Assistance Needs Across the U.S. MD: Center for Mental Health 

Services, Substance Abuse and Mental Health Services Administration, 2023. 

Originating Office 

Division of State and Community Systems Development, Center for Mental Health Services, Substance 

Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857. Published 

2023. 

Nondiscrimination Notice 

SAMHSA complies with applicable Federal civil rights laws and does not discriminate on the basis of 

race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos 

civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. 

Released 2023 
State Program Improvement TA Project iv

Table of Contents

Introduction ................................................................................................................................................. 1

Community Mental Health Block Grant Set Aside for Crisis Services ...................................................... 3

Launch of the 988/Lifeline......................................................................................................................... 3

Methodology................................................................................................................................................ 4

NRI State Profiling System........................................................................................................................ 4

MHBG Applications on WebBGAS ........................................................................................................... 5

ARPA Supplemental Funding Plans ......................................................................................................... 5

COVID-19 Relief Funding Plans ............................................................................................................... 5

Other Resources ....................................................................................................................................... 5

State of the States....................................................................................................................................... 6

Crisis Call Centers: Hotlines, Warmlines, and 988 ................................................................................... 6

Mobile Crisis Team Response .................................................................................................................. 8

Less-than-24-Hour Crisis Stabilization Units ............................................................................................ 9

Short-Term Crisis Residential Programs ................................................................................................10

Psychiatric Emergency Departments......................................................................................................11

Crisis Intervention Teams .......................................................................................................................11

Alternative Transportation for Individuals Experiencing a Behavioral Health Crisis ...............................12

Using Technology to Provide and Enhance the Delivery of Behavioral Health Crisis Services .............12

Oklahoma:...........................................................................................................................................13

Other Tablet Programs........................................................................................................................13

Ensuring Crisis Care Across the Continuum...........................................................................................13

Financing Crisis Services........................................................................................................................14

Barriers to Statewide, 24/7 Availability of Crisis Services and Related Technical Assistance Needs....16

The Transformation Transfer Initiative (TTI) Pipeline ...........................................................................17

Crisis Services for Special Populations ................................................................................................. 18

Crisis Services for LGBTQI+ Individuals................................................................................................. 19

Crisis Services for Racially and Ethnically Diverse Communities...........................................................19

Crisis Services for Older Adults ..............................................................................................................20

Crisis Services for Native Americans and Alaska Natives......................................................................20

Crisis Services for Children and Youth ...................................................................................................21

Crisis Services for Individuals Living in Rural and Remote Areas ..........................................................21

Crisis Services for Individuals with Co-Occurring Needs........................................................................22

Crisis Services for Veterans and the Military ..........................................................................................22

Use of Technology to Deliver Behavioral Health Crisis Services........................................................23

Use of Psychiatric Advance Directives in Crisis Prevention................................................................23
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Wellness Recovery Action Plans (WRAP) and Crisis Planning ...........................................................24

Use of Recovery Coaches and Partnerships with Recovery Community Organizations..................25

Availability of Same-Day and Follow-Up Appointments for Crisis Services ......................................26

Limitations on Use of Crisis Services.....................................................................................................28

Summary....................................................................................................................................................29

Appendix A: Examples of 911 Decision Trees.......................................................................................30

Appendix B: Efforts by SMHAs for Special Populations Identified in their MHBG, COVID-19 Relief 

Funds, and ARPA Plans ...........................................................................................................................33

Activities Identified to Improve Crisis Services for LGBTQI+ Individuals:...............................................34

Activities Identified by SMHAs to Improve Crisis Services for Racially and Ethnically Diverse 

Communities: ..........................................................................................................................................35

Activities Identified to Improve Crisis Services for Older Adults .............................................................37

Activities Identified to Improve Crisis Services for Native Americans and Alaska Natives.....................38

Activities Identified to Improve Crisis Services for Children and Youth ..................................................40

Activities Identified to Improve Crisis in Rural and Remote Areas..........................................................44

Activities Identified to Improve Crisis Services for Individuals with Co-Occurring Disorders .................46

Activities to Improve Crisis Services for Veterans and the Military.........................................................49

Tables and Figures

Figure 1: 2022 MHBG 5% Set-Aside for Crisis Services, Amount by State ................................................. 3

Table 1: Change in Contacts Before and After the Launch of 988 ............................................................... 4

Figure 2: Availability of MCTs Statewide and 24/7, 2022 (n=42).................................................................. 8

Figure 3: Funding Sources Supporting Mobile Crisis Teams, 2022 (n=42).................................................. 9

Figure 4: Funding Sources Used by States for CRPs, 2022 (n=35)...........................................................11

Figure 5: Use of MHBG Funds to Support Crisis Services, 2022 (n=41) ...................................................15

Table 2: Number of States Using Specific Funding Sources to Support Behavioral Health Crisis Services,

2022, (n=42)................................................................................................................................................15

Table 3: State Behavioral Health Agency Expenditures for Crisis Services, 2022 (n=42 states) ..............16

Table 4: Barriers to Statewide, 24/7 Implementation of Crisis Services, 2022 (n=42 states).....................16

Figure 6: Number of SMHAs Identifying Crisis Services for Special Populations in their 2022/2023 MHBG

Applications, COVID-19 Relief Plans, and ARPA Plans.............................................................................18

Figure 7: SMHAs Identifying Crisis Services for LGBTQI+ Individuals in MHBG, COVID-19, and/or ARPA 

Plans ...........................................................................................................................................................19

Figure 8: SMHAs Identifying Crisis Services for Racial and Ethnic Minorities in MHBG, COVID-19, and/or 

ARPA Plans ................................................................................................................................................19

Figure 9: SMHAs Identifying Crisis Services for Older Adults in MHBG, COVID-19, and ARPA Plans.....20

Figure 10: SMHAs Identifying Crisis Services for Native Americans and Alaska Natives in MHBG, COVID19, and ARPA Plans ...................................................................................................................................20

Figure 11: SMHAs Identifying Crisis Services for Children and Youth in MHBG, COVID-19, and ARPA 

Plans ...........................................................................................................................................................21
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State Program Improvement TA Project vi

Figure 12: SMHAs Identifying Crisis Services in Rural & Remote Areas in MHBG, COVID-19, and ARPA 

Plans ...........................................................................................................................................................21

Figure 13: SMHAs Identifying Crisis Services for Individuals with Co-Occurring Needs............................22

Figure 14: SMHAs Identifying Crisis Services for Veterans and the Military in MHBG, COVID-19, and 

ARPA Plans ................................................................................................................................................22

Figure 15: States Using Psychiatric Advance Directives in Crisis Prevention............................................24

Figure 16: States Using WRAP in Crisis Planning......................................................................................25

Figure 17: States Using Recovery Coaches and Partnering with Recovery Community Organizations....26

Figure 19: SMHAs with Ability to Make Same-Day and Follow-Up Appointments for Crisis Services .......27

Figure 20: SMHAs Able to Make Referrals for Post-Crisis Services ..........................................................28

Figure 21: Didi Hirsch 911 Call Diversion Flow...........................................................................................31

Figure 22: Broome County, NY’s 911 Call Diversion Emotionally Distressed Caller Risk Assessment.....32
Snapshot of Behavioral Health Crisis Services and 

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Introduction 

Treating and resolving behavioral health crises is one of the top priorities of any mental health system. 

Recently, the Substance Abuse and Mental Health Services Administration (SAMHSA) and states have 

invested tremendous effort and resources in both (1) establishing best practices for effective behavioral 

health crisis care systems and (2) creating the infrastructure for such systems to be accessible to everyone 

in the country, like other crisis systems (e.g., emergency medical services [EMS], law enforcement). The 

nationwide launch of the 988 Suicide & Crisis Lifeline (Lifeline) in July 2022 is the culmination of this 

effort. 

SAMHSA released its National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit

(National Guidelines) in 2020. This toolkit specifies that crisis care systems in the United States require 

three primary components and two support services. In November 2022, the Department of Health and 

Human Services, through SAMHSA, released the National Guidelines for Child and Youth Behavioral 

Health Crisis Care, drawing attention to the urgent need to improve behavioral health crisis response 

services for children, youth, and their families. These guidelines also outline how communities can work 

to address existing gaps in the crisis system for youth. As these guidelines were released after the 

research was conducted for this report, they are not specifically addressed in this inventory and 

environmental scan. 

The primary components of a behavioral health crisis care system are:

1. Regional crisis call center – a place to call: A call center, available 24/7 and staffed by

clinicians, that provides behavioral health crisis intervention via telephone, texting, and online

chat. In addition, the center should provide real-time crisis care coordination through “air traffic

control” technology (i.e., not just provide a referral, but ensure that a caller receives the care

indicated by their situation).

2. Mobile crisis team (MCT) – someone to respond: Usually a two-person team, which may

include both a clinician and peer specialist, that goes to wherever the person in crisis is (the

composition of MCTs may vary by state, depending on the availability of an adequate workforce,

as well as legislative requirements). If circumstances warrant, however, the team will respond

with law enforcement. When indicated, the team will provide a warm handoff to other treatment

services (including in some states the MCT transporting a client to a crisis receiving and

stabilization facility).

3. Crisis receiving and stabilization services – a place to go: This is a facility that offers less than

24-hour care for behavioral health crises. It follows a no-wrong-door approach (i.e., walk-ins and

anyone brought by MCTs, law enforcement, or emergency personnel will receive care). It is open

24/7 and staffed with a team capable of handling all levels of crisis.

In addition to the primary components, support services to a crisis care system include, but are not limited 

to: 

1. Short-term residential facility: A home-like facility, as an alternative to inpatient care, for

individuals experiencing crisis and who are assessed and determined to require medically

monitored, residential or non-residential services. These facilities cannot accept all referrals but

play an important role in a continuum of care.

2. Peer-operated respite program: Is also a short-term care facility but run by peers. It provides

access to a peaceful sanctuary for individuals after a crisis or seeking to avoid a crisis. Licensed

clinicians may assist the peer staff but are not usually part of the staff.
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Crisis services exist along a continuum according to the level of acuity of an individual’s crisis. These 

range from warmlines, which seek to prevent a crisis, to inpatient mental health treatment, a restrictive 

treatment modality that is a last resort. There are several primary entry points for this system: calls to a 

crisis hotline, interaction with law enforcement, admission to a medical facility (e.g., an emergency 

department [ED], or walk-in to a mental health provider (such as a CCBHC) or a crisis respite center). 

The expansion of the 988/Lifeline system has the ability to make the first entry point from the 988 

Suicide & Crisis Lifeline increasingly efficient. Its clinicians can coordinate next steps within the system 

for the individual experiencing crisis and dispatch an MCT (and/or law enforcement and/or EMS). The 

MCT can provide further treatment and a warm handoff to additional care as needed (e.g., crisis 

stabilization services, a short-term residential facility, a peer-operated respite facility, or ambulatory care). 

This method seeks to ensure that an individual experiencing crisis follows a path through the crisis care 

system that matches their level of crisis acuity and quickly leads to service. 

SAMHSA’s National Guidelines for Behavioral Health Crisis Care, as well as the National Guidelines 

for Child and Youth Behavioral Health Crisis Care emphasize that the three primary components of a 

crisis care system and support services must collaborate closely with each other and with the larger 

community behavioral health (including mental health and substance use) and hospital systems, to form 

an integrated, coordinated system of care.

Crisis Intervention Team (CIT). One focus of crisis integration is to shift in-person crisis responses 

away from law enforcement to community-based MCTs. The National Guidelines support a system that 

decreases the use of law enforcement officers (LEOs) in the response to many behavioral health crisis 

calls. When LEOs must respond to a behavioral health crisis, such as due to imminent danger or lack of 

available MCTs, the CIT approach integrates appropriate crisis service into law enforcement operations 

by providing behavioral health training to LEOs and sometimes partnering them with behavioral health 

and social services workers. Clinicians, social workers, and peers may accompany LEOs on calls or even 

respond in lieu of law enforcement, when appropriate. Research indicates that LEOs often encounter 

people with mental illness and transport people experiencing a mental health crisis to medical facilities, 

where they may spend a long time waiting for the person in crisis to be admitted. LEOs may instead 

transport a person experiencing a mental health crisis to a jail, which is an inappropriate and traumatizing 

setting for their behavioral health needs.1

 

Bed/Service Registry. A second important component of crisis care system coordination is a bed/service

registry, which many states are currently using or implementing, to ensure that individuals with 

behavioral health crises who need additional services can quickly receive these services. Ideally, a 

bed/service registry serves as a type of air-traffic control system that track the real-time availability of all 

appropriate behavioral health services, including the availability of outpatient appointments for 

individuals needing ambulatory follow-up, available crisis receiving and stabilization facility slots as well 

as residential and inpatient beds (for both mental health and substance use services). Several states are 

implementing Crisis Service Registries that not only track available services, but that permit making 

appointments or transmitting referral materials to reserve an appropriate treatment bed. Two major 

challenge for states and communities have been to ensure that the information about available services or 

beds is up to date and to involve the participation of all public and private behavioral health treatment 

providers in their region. While some registries focus only on tracking psychiatric beds, increasingly 

states are seeing these registries as a way to identify the most appropriate level of service and help the 

individual in crisis receive that service.
Snapshot of Behavioral Health Crisis Services and 

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Community Mental Health Block Grant Set Aside for Crisis Services 

In 2021, Congress directed SAMHSA to specify that states, territories, and the District of Columbia 

(“states”) set aside five percent of their community mental health block grant (MHBG) funds on 

evidence-based crisis services for adults with severe mental illness (SMI) and children with serious 

emotional disturbances (SED).2 This set-aside provided over $40 million of additional funding for crisis 

services.3

 Every state now has funding available to develop a robust continuum of crisis services, 

including (but not limited to) crisis call centers, MCTs, and short-term crisis stabilization services for 

both adults and youth. 

Given the variation in the amount of MHBG funds awarded to each state (see Figure 1), however, the 

crisis services set-aside provides more funding to some states than to others. The U.S. territories and 

Pacific Jurisdictions receive even lower MHBG allocations than most states, meaning the five percent setaside may not be enough to even fund a 24/7 call center. Therefore, for many states—especially the 

territories and Pacific jurisdictions—the ability to use local tax funds and to bill Medicaid, Medicare, and 

private insurance remains critical for a sustainable crisis care system. 

Figure 1: 2022 MHBG 5% Set-Aside for Crisis Services, Amount by State4

Launch of the 988/Lifeline 

In 2020, Congress designated 988 as the national dialing code for behavioral health crisis as an easy-toremember alternative to a 10-digit phone number.5 the nation transitioned to the 988/Lifeline system in 

July 2022. Formerly known as the National Suicide Prevention Lifeline, the 988 Suicide & Crisis Lifeline 

provides a easy to remember alternative to 911 for someone in crisis to access behavioral health crisis 
Snapshot of Behavioral Health Crisis Services and 

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State Program Improvement TA Project 4

services by finding a trained expert to talk with and can help to connect individuals to the most 

appropriate community resources. The Lifeline system now operates in all states, the District of 

Columbia, and several of the U.S. territories. Table 1 compares the number and mode of contacts to the 

Suicide & Crisis Lifeline and the nature of responses to them in June 2022 to those in August 2022, 

which was the first full month of operation for that system. During August, contacts increased 30 percent

over June, and the rate of abandoned calls decreased from 20 percent to 12 percent. 

Table 1: Change in Contacts Before and After the Launch of 9886

June 2022 August 2022 Change

Calls Chats Texts Total Calls Chats Texts Total Calls Chats Texts Total

Routed 184,819 85,263 7,335 277,407 256,398 64,115 40,627 361,140 38.7% -24.8% 453.9% 30.2%

Answered 83% 72% 96% 80% 84% 97% 98% 88% 1% 25% 2% 8%

Abandoned 17% 28% 4% 20% 16% 3% 2% 12%

Non-Lifeline call centers, however, still serve significant numbers of people. Twenty-six states that 

already operated crisis call centers before the rollout of the Lifeline are continuing to support these call 

centers. In these states, many behavioral health clients are accustomed to contacting their local crisis 

center (using a local 10-digit or three-digit number, such as 211) and the states are maintaining these 

numbers to ensure continuing access to crisis services. This paper presents data on both categories of call 

centers.

Methodology

Data and information used to compile this report are derived from a variety of sources, including NRI’s 

State Profiling System, 2022/2023 state mental health authority (SMHA) MHBG applications accessed 

via SAMHSA’s Web Block Grant Application System (WebBGAS), SMHA American Rescue Plan Act 

of 2021(ARPA) Supplemental Funding Plans, and SMHA COVID-19 Relief Plans. As such, unless stated 

otherwise (i.e., other, additional resources accessed during November 2022 are referenced throughout, 

where applicable), all statistics, figures, etc. come from these sources. A brief description of NRI’s State 

Profiling System and the MHBG applications are below. 

NRI State Profiling System 

The NRI State Profiling System consists of data derived from a series of surveys that collect detailed 

information about state behavioral health authorities’ (SMHAs) organizations and structures, service 

systems, eligible populations, emergency policies and service issues, fiscal resources and structure, 

consumers served, and additional timely and relevant topics (e.g., behavioral health workforce). NRI 

develops the Profiles surveys under the guidance of an advisory group comprising SMHA Commissioners 

and State MHBG Planners, as well as program, National Association of State Mental Health Program 

Directors (NASMHPD), and NRI staff. Each year, NRI sends the profile surveys to the SMHA

Commissioners, who designate contacts to complete and return the surveys to NRI. Select State Profiles 

reports are publicly available online at https://www.nri-inc.org/profiles. 

For the 2022 Profiles, NRI worked with NASMHPD and SMHA crisis service coordinators to design and 

conduct one survey to establish the current status of crisis services supported by state systems and another 

survey focused on the financing of crisis systems. The crisis services survey was sent to 50 states and the 

District of Columbia during the summer of 2022 and 48 SMHAs have responded. Forty-one SMHAs have 

responded to the finance survey (Note: The same SMHAs may not have responded to both). The NRI 

survey used the definitions contained in the SAMHSA National Guidelines for Behavioral Health Crisis

for call centers, mobile crisis Teams, and crisis receiving and stabilization facilities to guide state 
Snapshot of Behavioral Health Crisis Services and 

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State Program Improvement TA Project 5

reporting. The survey collected information about the models/composition of mobile crisis teams by state 

and the model and organization of crisis receiving and stabilization facilities. States can vary widely in 

exactly how they operationalize these types of crisis services, but for the purpose of reporting results, any 

program a state identifies as a MCT is reported as a MCT and any program identified as a CRSF is 

reported as CRSF (even if the state’s version of that service differs from the definition in the SAMHSA 

National Guidelines).

The crisis survey focuses on the three primary components of the crisis care system highlighted by 

SAMHSA’s National Guidelines and also gathered information about short-term crisis residential 

facilities, behavioral health emergency department (ED) initiatives, and coordination with law 

enforcement, including the coordination between 911 and 988 call centers. 

MHBG Applications on WebBGAS 

To determine SMHAs’ technical assistance (TA) needs related to crisis services, NRI examined each 

SMHA’s 2022/2023 MHBG application on WebBGAS. During October 2022, NRI staff reviewed 

Section 15: Crisis Services of each of the 59 states and territories’ 2022/2023 applications to identify any 

training and technical assistance (T/TA) needs related to implementing services within the crisis 

continuum. Based on this review, NRI staff identified 11 states with TA requests made through their 

MHBG applications. NRI staff also reviewed this section of the MHBG applications to identify efforts 

specific to special populations (e.g., LGBTQI+, racially and ethnically diverse communities, older adults, 

children and youth, Native Americans and Alaska Natives, and individuals living in rural and remote 

communities), SMHAs’ use of technology, relationships with recovery coaches and recovery 

organizations, the inclusion of psychiatric advance directives and wellness action recovery plans in crisis 

prevention, and other crisis-focused efforts.

ARPA Supplemental Funding Plans 

The American Rescue Plan Act of 2021 allocated additional funds through the Mental Health and 

Substance Use Block Grants to address the impacts of the COVID-19 pandemic on individuals with 

mental health and substance use disorders. States were required to submit their plans for using the ARPA 

funds to SAMHSA. SAMHSA encouraged states to focus their plans on activities that would support the 

behavioral health crisis continuum. Plans from each state were reviewed by NRI and NASMHPD staff in 

January 2023 for efforts related to the expansion and improvement of states’ crisis continuums.

COVID-19 Relief Funding Plans 

To help states address challenges brought on by the COVID-19 pandemic, HHS awarded emergency 

grants and cooperative agreements under the Coronavirus Aid, Relief, and Economic Security (CARES) 

Act. States were required to submit their plans for using the COVID-19 supplemental funds to SAMHSA. 

Plans from each state were reviewed by NRI and NASMHPD staff in January 2023. Information about 

how states proposed to use the funds are included in this report. 

Other Resources 

In addition to reviewing the NRI State Profiling System and the MHBG applications, researchers 

identified other T/TA needs related to crisis services through participation in regular calls with 

NASMHPD and the SMHA Commissioners. States undertaking unique and innovative approaches to the 

delivery of crisis services were also identified through these calls, as well as through NRI and 

NASMHPD’s work on SMI Adviser with the American Psychiatric Association and SAMHSA. 

Researchers also acquired information from Vibrant Emotional Health, the national Lifeline 
Snapshot of Behavioral Health Crisis Services and 

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State Program Improvement TA Project 6

Administrator, and other national behavioral health crisis service leaders’ websites. As stated above, these 

additional resources are referenced when included in the text.

State of the States

According to NRI’s 2022 State Profiles,7 of the 48 responding SMHAs, all offer at least one of the crisis 

services recommended in SAMHSA’s National Guidelines. Of those:8

• 100 percent fund or operate Lifeline call centers. 

• 65 percent fund or operate other 24/7 crisis hotlines. 

• 92 percent fund or operate mobile crisis response.

• 67 percent fund or operate less-than-24-hour crisis stabilization units (CSUs).

• 77 percent fund or operate crisis residential programs (CRPs) (more-than-24-hour programs). 

In addition:9

 

• 52 percent of all responding states embed behavioral health clinicians in EDs.

• 82 percent of SMHAs work with or train law enforcement to provide CIT. 

• 63 percent fund or operate crisis respite programs. 

It is important to note that the U.S. territories are also working to implement 988 across their

jurisdictions. American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, Puerto Rico, 

and the Virgin Islands are all leveraging cooperative agreements from SAMHSA to build local Lifeline 

capacity.10 The U.S. territories, however, especially the Pacific jurisdictions, face unique challenges, 

including a small population often spread across multiple islands and a limited provider workforce, which 

create obstacles for the provision of MCTs and the implementation of CSUs.11 

Tribal organizations are also working to implement the Lifeline. However, given the sovereignty of 

Native American tribes, some tribal organizations support their own 988 call centers and crisis 

continuums. The Lifeline presents an opportunity for state and tribal partners to come together. 

Crisis Call Centers: Hotlines, Warmlines, and 988 

As of April 2023, every state operates at least one Lifeline call center, and more than 200 Lifeline call 

centers are providing services.

12 In addition, as of the summer of 2022, 15 states are planning to open at 

least 18 additional Lifeline call centers. Many states are also working to expand the capacity of their 

existing call centers.13 The U.S. territories also operate at least one Lifeline call center but, due to a lack 

of reporting responses, the subsequent data will focus on the states. Of the Pacific jurisdictions, American 

Samoa and Guam operate 988/Lifeline call centers. The others are working on options to establish them.

In addition to the Lifeline call centers, many states continue to fund and support the operation of 

additional call centers and peer-operated warmlines. In 2022, 31 states reported supporting the operation 

of 344 additional call centers, which handled nearly 1.78 million crisis calls.14 Non-988 crisis call centers 

are primarily operated by community mental health providers (18 states), followed by Managed Care 

Organizations (MCOs; 6 states), Certified Community Behavioral Health Clinics (CCBHCs; 5 states), 

and directly by the SMHAs (2 states).15 Most of these independent call centers will continue to operate 

outside of the Lifeline network (20 states reporting).16

States report that while Lifeline and other crisis call centers handle millions of calls each year, major 

challenges remain to ensuring their operation 24/7.17 
Snapshot of Behavioral Health Crisis Services and 

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State Program Improvement TA Project 7

• Twenty-nine (29) states report that staffing call centers is a major challenge, especially for 

second, third, and weekend shifts.

• The second largest challenge is having adequate capacity to meet increased demand.

• Thirdly is sustainable financing for call centers. 

− Current funding for Lifeline call centers and other call centers comes from federal 988 

implementation funds (48 states), MHBG crisis set-aside funds (24 states), and state 

general funds (34 states).

− Only seven (7) states, however, report support for call centers via Medicaid 

reimbursement. 

− Only a few states have passed telephone fees (discussed later) to sustain ongoing call 

center operations. 

Additionally, states are struggling to establish rules to coordinate calls between 911 public safety 

answering points (PSAPs) and Lifeline call centers. Only nine states reported having current agreements 

with 911 systems about when to divert calls to or from crisis call centers. Most states reported a need for 

developing decision trees and operational rules between the two systems.

18 The challenge establishing 

these relationships may be due to the fact that many PSAPs are operated locally and more than one PSAP 

can exist per area code. Therefore, states will need to develop relationships with multiple local PSAPs

instead of having one state-wide set of 911 and 988 decision rules. See Appendix A for examples of 911 

decision trees that may be modified to help 911 and 988 systems better collaborate to appropriately direct 

calls.

Organizations across the country are also making accommodations to ensure that services are accessible 

and equitable for special populations. An example of this is DeafLEAD’s (Leadership, Esteem, Ability, 

Discipline) 24-hour crisis hotline and texting services, based out of Columbia, Missouri. DeafLEAD 

ensures that crisis services are available to all individuals who are D/deaf, DeafBlind, hard of hearing, 

late-deafened, and hearing. 

Another method to improve the relationship between 911 and 988 crisis call centers is to 

physically embed crisis call centers into 911 facilities. The Harris Center for Mental Health and 

IDD (intellectual or developmental disabilities) in Houston, Texas, began implementing this 

model in 2015 to reduce the unnecessary burden on LEOs of responding to behavioral health 

crises and to provide more appropriate, proactive care to individuals in need. Behavioral health 

call takers undergo rigorous training to encourage confidence in the program and with the 

emergency communications team. Call takers are required to have, at minimum, a bachelor’s 

degree in psychology, sociology, or a related field and receive training on CIT, cultural awareness 

and trauma-informed care, rapport building and empathetic listening, privacy and confidentiality, 

assessing for suicidal and homicidal ideation, safety planning and de-escalation, and mandatory 

reporting scenarios. Between June 2017 and March 2021, the program diverted more than 

3,000 calls from fire department response, and 7,500 calls from law enforcement response, 

saving more than $6.5 million across the 2 departments over the 4 years.

Source: Neylon, K. (2021, December 14). Embedding crisis response in Harris County’s 911 dispatch center. #CrisisTalk. 

https://talk.crisisnow.com/embedding-crisis-response-in-harris-countys-911-dispatch-center/
Snapshot of Behavioral Health Crisis Services and 

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State Program Improvement TA Project 8

Mobile Crisis Team Response 

Forty-four of the 48 responding states reported either currently supporting MCTs or working to establish 

teams this year.19 

• Forty-four (44) states reported a total of 1,287 MCTs, including 110 mobile child/adolescentdedicated crisis teams in 15 states. 

• Thirty-one (31) states reported plans to open at least 173 additional MCTs during the year. 

• In 2021, MCTs across 28 states served 512,305 individuals experiencing a behavioral health 

crisis.

• Regarding operation of MCTs: 

− In 35 states, community mental health providers operate MCTs. 

− In 15 states, CCBHCs operate them.

− In seven states, the SMHA itself operates the MCTs, while MCOs have established 

MCTs in four states. 

− Ten (10) states use other organizational arrangements to operate these services, including 

combinations of the previously listed organizations. 

Although states are supporting MCTs, many states report that these services are not yet available 

statewide. It is especially challenging to implement MCTs in rural and remote areas, and it is also difficult 

to secure sufficient staffing to maintain operation 24/7. Figure 2 shows that only 24 states report that 

MCTs are available statewide, and even fewer (20 states) have MCTs that can respond to individuals in 

crisis 24/7. 

Figure 2: Availability of MCTs Statewide and 24/7, 2022 (n=42)20

As Figure 3 illustrates, states are supporting MCTs using funding from a variety of sources, with 

Medicaid, state general funds, and the SAMHSA MHBG 5 percent crisis set-aside the most frequent 

funding sources leveraged by states. 

24

20 20

23

1

0

5

10

15

20

25

30

Available

Statewide

Available in

Regions of

States

All MCTs are

24/7

Some are 24/7 None are 24/7

Number of States
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 9

Figure 3: Funding Sources Supporting Mobile Crisis Teams, 2022 (n=42)21

A third of the responding SMHAs are monitoring outcomes related to MCTs.22 Of MCT dispatches:

• 46 percent end with an outpatient behavioral health appointment being made (15 states 

responding). 

• 12 percent end with an individual transferring to a CSU for additional care (15 states responding). 

• 14 percent end with an individual going to an ED (15 states responding).

• 37 percent end with an individual being referred to outpatient behavioral health services (16 states 

responding). 

Less-than-24-Hour Crisis Stabilization Units23

Thirty-four (34) states report a total of 237 crisis stabilization programs, including 21 programs across 

seven states that specialize in serving children and adolescents. Twenty-one (21) states reported plans to 

open 139 additional CSUs in the next year. In 19 states CSUs, although designed to provide short-term, 

less-than-24-hour care, are permitted to continue to serve individuals in crisis beyond 24 hours if 

additional time is needed. Thirteen (13) states require CSUs to maintain less-than-24-hour treatment. 

Regarding operation:24

• Community mental health providers operate CSUs in 27 states

• CCBHCs operate them in eight (8) states. 

• SMHAs operate CSUs in four (4) states.

• MCOs operate them in two (2) states. 

• Nine (9) states describe alternative organizations operating CSUs. Many of them report a 

combination of organizations supporting CSUs. 

Assuring these programs are available statewide and 24/7 is a major challenge for nearly all states. Only 

eight of the responding states report CSUs available statewide. Those available facilities, however, tend to 

be in operation 24/7; only four states reported that their CSUs are not open 24/7. States describe 

continuing challenges hiring and maintaining a workforce to keep these facilities open 24/7. Major 

barriers to operating CSUs statewide, 24/7 include:

25: 

41 39

19 19

16

10

6

1

0

5

10

15

20

25

30

35

40

45

Medicaid State Funds MHBG 5%

Crisis Setaside

New

Medicaid

Mobile

Crisis

Option

Additional

MHBG

Other

SAMSHA

Other Phone Fee

Number of States
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 10

• Workforce (24 states)

• Financing (9 states)

• Issues related to operating the programs in rural and remote areas (4 states). 

Another issue commonly cited by states is insufficient information regarding available beds or outpatient 

behavioral health services, which complicates making referrals for clients leaving CSUs.

26

Twenty-seven percent of states are collecting outcomes data about CSUs.27 Nine (9) states report 

receiving data about the disposition of CSU-served individuals.

28

• Seven states indicate that an average of 51percent of clients have their immediate crisis resolved 

at the CSUs.

• 73 percent of clients are discharged from a CSU with a referral or follow-up outpatient services 

(five states responding). 

• Only five (5) percent of clients are transferred to an ED (eight states responding). 

• Thirteen (13) percent of clients require further care at a psychiatric hospital or substance use 

disorder withdrawal management facility (seven states responding). 

Short-Term Crisis Residential Programs 

CRPs are a resource for individuals who need continually monitored care but do not require more 

intensive psychiatric inpatient or substance use disorder withdrawl management treatment. Thirty-seven 

(37) states support short-term CRPs, which together served 118,383 individuals in the prior year. Of those 

states with figures available:

29

• 516 CRPs are currently serving behavioral health clients in 37 states.

• 26 states are working to open 100 additional programs. 

• In 14 states, CRPs are available statewide. In 27 states, they are available only in parts of a state.

Regarding operation:30: 

• Community mental health providers operate CRPs in 35 states.

• CCBHCs operate them in 11 states.

• SMHAs operate them directly in five states.

• MCOs operate CRPs in two states.

• A variety of other organizational types operate them in 10 states.

As Figure 4 shows, CRPs are funded by state general funds in 30 states, by Medicaid in 21 states, and by 

MHBGs in 11 states. (Note: Due to the Medicaid IMD (Institutions for Mental Disease) Rule, CRPs with 

more than 16 beds may be ineligible for MHBG funding or Medicaid reimbursement if they serve adults 

ages 21 through 64). 
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 11

Figure 4: Funding Sources Used by States for CRPs, 2022 (n=35)31

Barriers to expanding crisis residential services include insufficient workforce (24 states), followed by 

insufficient bed capacity (9 states) and sustainable funding (8 states).

Psychiatric Emergency Departments 

Initiatives to provide behavioral health expertise to hospital EDs are ongoing in 25 states. These 

initiatives include funding mental health experts to work in EDs or with hospitals to establish dedicated 

spaces with trained staff to address behavioral health crises. For example, one state responded in the 2022 

state profiles that “some hospitals have created separate spaces with specialized staff to address 

psychiatric emergencies in the ED.”32

Crisis Intervention Teams 

The CIT approach trains LEOs on how to (1) work as a team to identify and safely support the immediate 

needs of individuals with behavioral health conditions (2) divert individuals from incarceration. Its 

objectives are to:

• Decrease the risk of harm to individuals in crisis

• Promote decriminalizing individuals with a mental illness

• Lessen the stigma associated with mental illness

• Reduce injuries to LEOs

In the 2022 State Profiles,

33 37 SMHAs report working with law enforcement agencies to provide CIT 

training. In 26 states, SMHAs provide some of the funding to support this training. 

34

24

11

0

5

10

15

20

25

30

35

40

State General Fund Medicaid Other MHBG

Number of States

As an example, Montana includes CIT training as part of its law enforcement academy and makes 

the training available throughout an LEO’s career. The state has found that incorporating CIT has 

helped to shift the culture in the state surrounding law enforcement’s response to mental illness. 

The training in Montana has evolved over time to incorporate peer-to-peer training, in which LEOs 

train other LEOs on how to best address mental health issues.

Source: Ezekiel, N., Malik, C., Neylon, K., Gordon, S., Lutterman, T., & Sims, B. (2021, August). Improving behavioral health services 

for individuals with SMI in rural and remote communities. Washington, D.C., American Psychiatric Association for SAMHSA, p. 51. 
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 12

Alternative Transportation for Individuals Experiencing a Behavioral Health 

Crisis 

Historically, individuals experiencing a behavioral health crisis are transported to EDs, hospitals, or CSUs 

by law enforcement in marked police cars and often require those transported to be restrained, usually 

with handcuffs. Requiring transportation for behavioral health services by LEOs can be very stigmatizing 

and traumatizing to the individual in crisis and burdensome to law enforcement by taking them away from

other duties. 

According to the 2022 state profiles:34

• In 30 states MCTs can transport clients for additional crisis services (although in some states 

MCT can only transport voluntary individuals and LEO must transport individuals for involuntary 

care).

• Twelve (12) states have developed alternatives for transportation of individuals in crisis, and 12 

others are working to change policies and/or laws that require law enforcement or EMS to 

conduct transport. 

• In 24 states, rules still require LEOs to transport individuals to CSUs, EDs, or psychiatric 

hospitals. 

• In nine states, when LEOs transport clients, rules require the individual to be restrained during 

transport. 

• In 22 states, EMS services can transport clients; however, in four states, EMS are required to 

transport individuals to EDs and are not permitted to transport to CSUs. 

Using Technology to Provide and Enhance the Delivery of Behavioral 

Health Crisis Services 

Many technologies exist to facilitate and enhance the delivery of crisis services, particularly for 

connecting with a crisis counselor and for mobile crisis response. Although it is unknown exactly how 

many states are leveraging technology to provide these services, several model examples are available, 

San Luis Valley Behavioral Health Group in Colorado has developed a unique program to provide 

secure, comfortable, recovery-oriented transport to individuals to appropriate care. In 2017, this 

community provider in a remote part of the state piloted a program, through funding from the 

SMHA and Beacon Health Options (a Medicaid administrative services organization), to make a 

fleet of vehicles safe for specially trained drivers to transport individuals in crisis to care. The provider 

contracts with a private security company that employs former LEOs to serve as drivers, with each 

transport including two drivers for safety. The agency retrofitted two Ford Explorers with Plexiglass to 

create a secure area in the back of the vehicle, along with cameras to further ensure the safety of 

both the drivers and the passenger. All drivers are trained in CPR and Mental Health First Aid and 

given additional training on how to build rapport with their clients. Each vehicle also provides snacks 

and cold drinks for riders to consume, as well as blankets for added comfort

Source: Ezekiel, N., Malik, C., Neylon, K., Gordon, S., Lutterman, T., & Sims, B. (2021, August). Improving behavioral health services 

for individuals with SMI in rural and remote communities. Washington, D.C., American Psychiatric Association for SAMHSA, p. 18-19.
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 13

including an iPad program in Oklahoma (discussed below) and the use of telehealth for mobile crisis in 

South Carolina.35

Oklahoma: GRAND Mental Health (GRAND) Tablet Program 

Oklahoma has large regions of the state that are low density, requiring MCTs to respond over great 

distances. GRAND is a CCBHC in northern Oklahoma that operates 22 behavioral health clinics across 

12 counties, covering an area of more than 10,000 square miles. In 2016, the Oklahoma SMHA

incentivized providers to develop alternatives to inpatient care that reduce hospitalization rates across the 

state. These alternatives enable community-based providers to use funds that would normally support 

hospitalization. GRAND opted to reallocate these funds to enhance crisis services across its large 

catchment area. 

As part of this effort, GRAND began distributing iPads at the time of discharge to all recipients of crisis 

services at their facilities. The tablets support only one application (to conform with Medicaid rules and to 

discourage theft of the devices) and are set up to enable individuals to immediately connect to qualified 

staff, 24/7, at GRAND’s centrally located intensive outpatient center. GRAND has also expanded the 

program to provide tablets for LEOs and EDs in the region 

In its first year of operation, GRAND distributed nearly 500 iPads to individuals, local law enforcement, 

and local EDs. LEOs within the catchment area have tablets that enable them to (1) immediately connect 

with mental health services providers to help triage crisis situations in the field, thereby reducing the need 

for officers to transport individuals in crisis, and (2) connect directly with a clinician specialized in 

serving LEOs who experience their own crises related to traumas they faced in the field. While few 

officers have taken advantage of the officer-specific services, the existence of the service has helped to 

improve relations between the mental health provider and the law enforcement community across the 

state.36 

After implementing the program, inpatient hospitalization for adults within the GRAND catchment area 

decreased more than 93 percent between 2015 and 2021. Cost savings realized from reduced inpatient 

hospitalizations since the inception of the program total an estimated $62 million. The implementation of 

this program also enabled LEOs to save time and mileage. In January 2022 alone, officers across the 

catchment area reduced time transporting clients by nearly 830,000 minutes.37 

Based on the success of this program, Oklahoma used federal stimulus funds to purchase iPads for every 

law enforcement vehicle in the state. Each iPad has an app on the home page that connects the LEO to the 

closest regional CCBHC crisis center. Each of the CCBHCs in Oklahoma now has a staffed team of crisis 

workers, who are available 24/7 to answer iPad crisis calls. When a LEO responds to a call from an 

individual experiencing a behavioral health crisis, they use the iPad app to connect to the regional crisis 

team and then hand the iPad to the individual in crisis.

Other Tablet Programs 

New Mexico is currently replicating the use of iPads to augment mobile crisis response, and other states 

are examining the potential use of this type of technology to enhance crisis response in rural and remote 

areas.

Ensuring Crisis Care Across the Continuum 

It is vital that the three critical components of a crisis service continuum recommended by the National 

Guidelines coordinate to ensure that individuals in need do not “fall through the cracks,” especially as 
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 14

more individuals engage with the behavioral health system through the Lifeline. To facilitate this 

coordination, states and providers will need to find a way to work together and with Lifeline call centers 

to collect data, monitor outcomes, and implement continuous quality improvement plans. Several states, 

including Georgia, Arizona, and Tennessee, have implemented strategies to better coordinate care across 

the crisis continuum. 

Georgia. The Georgia Crisis and Access Line (GCAL) is an exemplary model for how components of the 

crisis continuum can work together to provide seamless crisis care. According to the state’s MHBG 

application, GCAL was implemented in 2006, when the Department of Behavioral Health and 

Developmental Disabilities (DBHDD) made the decision to centralize multiple call centers into one. 

Callers can now access the crisis hotline through call, text, or chat through 988, a 1-800 number, or 

through the My GCAL app. GCAL offers triage services and referrals to outpatient and specialty 

providers, serves as the single point-of-dispatch for MCTs, and manages the live referral and beds 

inventory for the state’s crisis stabilization program. This one point-of-contact enables the system to 

ensure that individuals move seamlessly through services as needed. DBHDD also relies on data to 

monitor how well its system is working, receiving crisis services data on a daily, weekly, monthly, and 

quarterly basis. These data are used to generate reports and to populate internal dashboards that are used 

to ensure system effectiveness and accountability.38

Arizona. Arizona's crisis system is also identified as an exemplary program because its 24/7 crisis hotline 

which is able to respond to individuals in need telephonically and to dispatch MCTs across the state.39

MCTs are available 24/7, statewide, and are “staffed by behavioral health professionals who travel to the 

individual experiencing a crisis, provide assessment and stabilization, and if needed, triage the individual 

to a higher level of care,” which may include transfer to a facility-based crisis stabilization unit.40 The 

crisis services offered in Arizona are able to serve any individual, regardless of insurance coverage. 

Tennessee. In 2021, the Tennessee Department of Mental Health and Substance Abuse Services

(TDMHSAS) implemented a comprehensive data monitoring system in response to providers expressing 

areas of need within the crisis continuum. This enabled TDMHAS to thoroughly examine the data it did 

collect to see if it could identify gaps in the crisis system. It determined that it could not. Strong 

leadership from the SMHA Commissioner enabled TDMHSAS to significantly enhance its crisis 

management data system. To do this, the SMHA brought together a variety of stakeholders representing 

various groups and expertise, including information technology, hospitals, SMHA staff, TennCare 

(Medicaid), and providers. This enhanced data system, which can be publicly viewed on the Tennessee 

Open Data Portal, also enabled the state to better align crisis services across agencies and providers.41

Financing Crisis Services 

As discussed earlier, in 2021, Congress added over $41 million of new funds to the MHBG as a new 5 

percent set-aside dedicated for crisis services. SAMHSA distributed these funds to states with guidance to 

use these funds to plan for and implement the continuum of crisis services from the National Guidelines. 

These new set-aside funds provide states with flexible funds dedicated to crisis services, and states report 

using them to support the components of their crisis system with the greatest need. As Figure 5 details, in 

24 states, the SMHAs dedicated the set-aside funds to support Lifeline call centers, while other states used 

funds for MCTs, CSUs, or other aspects of their crisis continuum. In addition to using the new 5 percent 

set-aside funds, many states report devoting additional MHBG funds beyond the set-aside to support 

portions of their crisis continuum. 
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 15

Figure 5: Use of MHBG Funds to Support Crisis Services, 2022 (n=41)42

State general funds and the MHBG are the most frequently cited funding sources for all behavioral health 

crisis services. Although the MHBG stipulates that states spend at least 5 percent of their MHBG on crisis 

services, the states indicate they are spending more than 5 percent of their MHBG funds on crisis 

services. 

States identified Medicaid as another significant funding source for financing crisis services; however, 

they use Medicaid primarily to support face-to-face crisis services through MCTs, CSUs, and CRPs. Only 

a few states use Medicaid to support crisis call centers (either Lifeline or other behavioral health call 

centers). 

Five states have passed legislation for a telephone tax (phone fee) to support behavioral health crisis 

services, as Table 2 shows. For example, phone fees in Virginia are limited to paying for Lifeline call 

center operations, whereas in Washington (State), they support the call centers, as well as MCTs, CSUs, 

and technology platforms for call centers and the crisis service delivery system.

Table 2: Number of States Using Specific Funding Sources to Support Behavioral Health Crisis Services, 

2022, (n=42)43

Funding Source Lifeline

NonLifeline 

Call 

Centers

Mobile 

Crisis 

Teams

<24-Hour 

Crisis 

Stabilization

Crisis 

Residential 

Programs

State General Funds 34 20 39 29 34

MHBG 5% Set-Aside 24 7 19 6 9

Other MHBG Funds 21 9 16 7 11

Other SAMHSA Funds 30 7 10 3 4

Medicaid 7 8 31 24 24

New Medicaid MCT Option N/A N/A 119 N/A N/A

Cell/Phone Fees44 5 0 3 1 0

Other Funding Sources 17 11 6 11 8

In 2022, as shown in Table 3, 42 states reported expending more than $1.5 billion to support their 

behavioral health crisis service continuums, with most funds allocated toward Crisis Residential 

24

7

19

6

9

21

9

16 16

7

11

0

5

10

15

20

25

30

Lifeline/988 Call

Centers

Non-Lifeline Call

Centers

Crisis Warm-lines Mobile Crisis

Teams

<24 Hour Crisis

Receiving &

Stabilization

Facilities

Crisis Residential

Programs

Number of States

MHBG 5% Set-Aside Other MHBG
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 16

Programs (more than $455 million). This is a significant underestimate as only 42 states were able to 

report expenditure data for crisis services.

Table 3: State Behavioral Health Agency Expenditures for Crisis Services, 2022 (n=42 states)45

State 

Spending on 

Crisis 

Services Total

Average Per 

State

Number of 

States 

Reporting

Number of 

Programs/

Centers

(Across All 

States)

Average Per 

Program/Center*

Lifeline Call 

Centers

$310,901,176 $7,582,956 41 185 $1,839,652

Non-Lifeline 

Call Centers

$75,328,499 $5,021,900 15 344 $706,892

Mobile Crisis 

Teams

$405,360,818 $16,214,433 25 1,287 $535,201

<24-Hour 

Crisis 

Stabilization

$307,915,440 $13,996,156 22 237 $2,070,830

Crisis 

Residential 

Programs

$455,809,253 $19,817,794 23 407 $1,673,611

Total: $1,555,315,186 $37,031,314 42 2,460 ---

*Note: not all states reporting the number of crisis programs were able to report expenditures for crisis services. Average 

Expenditures per Program is calculated based on expenditures of reporting states divided by the number of programs in each 

state reporting expenditure data.

Barriers to Statewide, 24/7 Availability of Crisis Services and Related 

Technical Assistance Needs

All responding states are working to implement a robust behavioral health crisis services continuum, 

however, barriers common to all emerged to 24/7 statewide implementation.

Across call centers, MCTs, and CSUs, workforce and financing are the most frequent barriers identified 

by states, followed by the challenges related to providing crisis services in rural and remote parts of the 

state. Table 4 lists the types of barriers cited by states, along with which crisis services the barriers affect.

Table 4: Barriers to Statewide, 24/7 Implementation of Crisis Services, 2022 (n=42 states)46

Barrier to Statewide, 24/7 Access

All Call 

Centers

Mobile Crisis 

Teams

<24-Hour 

Crisis 

Stabilization

Workforce 29 34 35

Financing 8 11 9

Rural/Remote 2 20 4

24/7 Operation and Staffing 4 5 8

Data/Internet 8 0 1

Transportation 0 8 2

Capacity/Meeting Anticipated Increased Demand 9 5 4

Lack of Available Beds 0 8 1

In addition to these barriers, SMHAs identified other areas of TA needs through their MHBG 

applications. Section 15 of the application specifically asks states for TA requests related to the expansion 

and delivery of crisis services. In the fiscal year 2022/2023 MHBG applications, 11 states and territories 

(District of Columbia, Illinois, Kansas, Kentucky, Michigan, Montana, Nevada, New Hampshire, Palau, 
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 17

Puerto Rico, and U.S. Virgin Islands) identified a need for TA in crisis services, the second most 

commonly identified area of need behind the implementation of evidence-based practices for early 

SMIs.47

Echoing challenges identified in the state profiles, specific areas of TA need states noted in their 

applications include:

48

• Transitioning behavioral health crisis calls from 911 to the Lifeline and the crisis service system

• Financing crisis services, especially because the Lifeline increased demand

• Establishing best practices in mobile crisis response, especially in rural and remote areas

Other TA needs SMHAs identified and submitted to NASMHPD’s divisional listservs include:

49

• How the IMD exclusion affects the delivery of crisis stabilization services

• Transportation and mobile crisis (i.e., how to finance and to develop policy to support)

• How to address complex cases that involve risk of self-injurious behaviors

• Use of screening tools for suicidality

• Crisis prevention, de-escalation, and intervention training for law enforcement

• Providing MCTs to youth and adolescents

• Appropriate crisis stabilization and crisis receiving services for youth and adolescents and how to

fund in-home crisis stabilization

• Suicide prevention for youth and adolescents

• Using the Medicaid Rehabilitative Services Option to finance crisis services

• Information sharing between 911, 988, and EMS around the needs of Lifeline callers

The Transformation Transfer Initiative (TTI) Pipeline

SAMHSA, through the Transformation Transfer Initiative (TTI) administered by NASMHPD, has been 

supporting states in implementing comprehensive behavioral health crisis systems for several years. In 

2022, a major focus of TTI funding awards was addressing behavioral health workforce needs in crisis 

call centers, mobile crisis teams, crisis receiving and stabilization facilities, and diversion initiatives. In 

2023, SAMHSA’s TTI project is supporting over 50 state funding awards that expand the work of states 

in addressing workforce challenges in their crisis service systems. NRI is working with NASMHPD and 

the 2022 and 2023 TTI states to document their lessons learned and the impact of their projects. During 

2023, NRI and NASMHPD will hold webinars and produce reports to share lessons learned from the TTI 

projects with state and local community crisis providers.

SAMHSA TTI funding has supported states developing training curricula for peer specialists and other 

behavioral health workers. For example, Utah used their TTI funds to develop a Crisis Worker 

Curriculum and Certification Program and have shared their work with other states. Mississippi 

developed a court liaison position that helps individuals with a behavioral health disorder who are 

involved with the criminal justice system access community-based behavioral health services. The goal of 

this position is to get people into appropriate care sooner and reduce usage of acute inpatient psychiatric 

services. New Jersey is planning to enhance the role of peers within the state by establishing a peer 

mentorship program and an advanced level training curriculum for peers. The Northern Mariana Islands 

will use TTI funds to increase the number of certified behavioral health professionals and to create a 

training program for certified behavioral health aides. 
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 18

As noted earlier, Oklahoma is an early leader of innovative initiatives to improve crisis services. 

Oklahoma used TTI funds to develop a Clinical Training Center of Excellence to manage the training of 

new and existing behavioral health staff, with a goal to increase the use of evidence-based practices and 

consistent service delivery throughout the state. Oklahoma has also increased access to behavioral health 

professionals during crises by developing applications that enables LEOs to use iPads to immediately 

connect individuals in crisis to qualified crisis workers 24/7. Oklahoma has shared their experience using 

tablets to enhance access to the behavioral health workforce in other states. Delaware, New Mexico, New 

York, South Carolina, South Dakota, and others are building on the Oklahoma experience to use 

technology that enhances access to behavioral health crisis professionals. 

Crisis Services for Special Populations

In their MHBG Applications, COVID Relief Funding Plans, and ARPA Plans, states identified efforts to 

tailor crisis services for individuals among special populations, including the LGBTQI+ community, 

racial and ethnic minorities, older adults, Native Americans/Alaska Natives, children and youth, veterans, 

and individuals living in rural and remote areas of the country. SMHAs most often identified services for 

children and youth in each of their applications, followed by services for individuals with co-occurring 

substance use needs, and for individuals living and receiving services in rural and remote areas. See 

Figure 6. 

Figure 6: Number of SMHAs Identifying Crisis Services for Special Populations in their 2022/2023 MHBG 

Applications, COVID-19 Relief Plans, and ARPA Plans

The sub-sections below provide an overview of efforts related to serving special populations in crisis 

services systems that SMHAs identified in their MHBG, COVID-19 relief fund, and ARPA plans. A 

complete list of efforts identified by states related to special populations are listed in Appendix B.

16

21

13

18

43

29

26

11

0

5

10

15

20

25

30

35

40

45

50
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 19

Crisis Services for LGBTQI+ Individuals 

Sixteen states and territories (CO, CT, KS, 

KY, MA, MI, MN, NJ, NM, OR, PR, PW, UT, 

VA, VI, WA) identified crisis services for 

individuals in the LGBTQI+ community in at 

least one of their MHBG, COVID-19, and/or 

ARPA plans submitted to SAMHSA (Figure7). 

Most plans focus on training the mental health 

and crisis workforce to respond to the unique 

needs of individuals within the LGBTQI+

community. The SMHAs in Kansas and Puerto 

Rico identified specific activities related to

improving Lifeline services for LGBTQI+

individuals. New Jersey plans to increase 

outreach, treatment, and services to LGBTQI+

individuals engaged with the acute care system 

and to enhance mobile outreach for this population. Michigan’s SMHA is tracking the demographic 

characteristics of individuals who present in crisis centers, including individuals who identify as 

LGBTQI+. Oregon is developing crisis response strategies for working with LGBTQI+ individuals who 

are at higher risk for suicide, and is using ARPA funds to support trainings for providers that focus on 

how to better meet the needs of underserved communities.

Crisis Services for Racially and Ethnically Diverse Communities 

Twenty-one states and territories (AZ, CT, KS, 

ME, MA, MN, NE, NV, NJ, NM, NC, OH, OR, 

PA, PR, RI, UT, VA, WA, WI, WY) recognized

racially and ethnically diverse communities in 

their 2022/2023 MHBG applications, COVID-19 

relief plans, and/or ARPA plans submitted to 

SAMHSA (Figure 8). Few narratives describe 

how crisis services systems will be tailored to 

address the unique needs of diverse racial and 

ethnic communities; however, SMHAs 

acknowledge that individuals from these 

communities are over-represented in the mental 

health and correctional systems and are training 

providers and staff to provide culturally 

responsive services to these diverse communities 

to improve services and outcomes. Oregon has 

developed an advisory workgroup to focus on improving overall crisis services for Black, Indigenous, 

People of Color (BIPOC) communities, and Virginia is establishing networks of crisis providers to ensure 

that there is robust representation and relationships between the regional mobile crisis hubs and peer-led 

and BIPOC-led crisis services networks and providers, research organizations, and social and racial 

justice-focused behavioral health organizations. Wisconsin acknowledged in its COVID-19 relief plan the 

need to support historically underserved communities in its crisis services system and will do so through 

Figure 7: SMHAs Identifying Crisis Services for LGBTQI+

Individuals in MHBG, COVID-19, and/or ARPA Plans

Figure 8: SMHAs Identifying Crisis Services for Racial 

and Ethnic Minorities in MHBG, COVID-19, and/or 

ARPA Plans
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 20

the implementation of a statewide warmline run by peers who will support diverse populations across the 

state and identify as Latinx, Black, or Hmong. 

Crisis Services for Older Adults 

Thirteen states and territories (KY, ME, MD, 

NJ, NY, NC, OH, OR, PR, MH, VA, VI, WA) 

identified efforts related to improving services 

for older adults in their 2022/2023 MHBG 

applications, COVID-19 relief plans, and/or 

ARPA plans submitted to SAMHSA (Figure 

9). Many of the efforts are related to training 

behavioral health providers, including 

specialized older-adult peers, to specifically 

work with the older adult population. SMHAs 

are also implementing a variety of upstream 

activities that can reduce older adults’ needs 

for crisis services. Oregon is developing crisis 

response strategies for working with older 

adults. Puerto Rico provides a specialized 

crisis hotline for older adults, ages 55 and up. The Marshall Islands recognizes that older adults are an 

important consumer of the services offered through their 24/7 crisis system.

Crisis Services for Native Americans and Alaska Natives

Eighteen states and territories (AK, AZ, CO, KS, ME, MI, MT, NV, NJ, NM, NC, OR, PR, SD, UT, WA, 

WI, WY) identified activities related to improving services for Native Americans and/or Alaska Natives 

in their 2022/2023 MHBG applications, COVID-19 relief plans, and/or ARPA plans submitted to 

SAMHSA (Figure 10). Most of these states are collaborating with tribal communities and governments to 

ensure that services are culturally relevant and meet the unique needs of tribal populations. Alaska’s 

SMHA recognizes a need to improve access to tribal communities, because many do not have roads that 

connect to nearby villages, and the only way to travel in and out safely is by air or water. Increasing 

access to and the availability of crisis services 

in these areas will prevent individuals, 

including children and youth, from being 

transported hundreds of miles away from their 

homes, families, and cultural traditions. 

Providers in Arizona must have a 

collaborative agreement in place, whereby 

tribal liaisons and appropriate clinical staff 

coordinate crisis services on tribal lands with 

tribal providers. Colorado is using ARPA 

funds to provide Ute Mountain Ute first 

responders with mental health awareness 

training and crisis mitigation outreach peer 

services. Maine’s Wabanaki Care Line and 

other multiple tribal domestic lines 

supplement crisis services offered directly by 

the SMHA. Michigan’s Crisis and Access 

Figure 9: SMHAs Identifying Crisis Services for Older 

Adults in MHBG, COVID-19, and ARPA Plans

Figure 10: SMHAs Identifying Crisis Services for Native 

Americans and Alaska Natives in MHBG, COVID-19, 

and ARPA Plans
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 21

Line is being developed in partnership with tribal communities. Nevada is working with tribal populations 

to expand Mental Health First Aid, postvention training, and county-specific interventions. New Mexico 

designed its Crisis Now continuum of services with input from tribal communities.

Crisis Services for Children and Youth 

Most (43) states and territories identified 

activities and/or needs related to improving 

crisis services for children and youth in their 

2022/2023 MHBG applications, COVID-19 

relief plans, and/or ARPA plans submitted to 

SAMHSA (Figure 11). Nearly half (20) of 

these SMHAs identified efforts to expand and 

improve mobile crisis services for children 

and youth (AK, CA, CT, DE, DC, GA, HI, ID, 

MA, MI, MO, NJ, NE, NM, OH, OR, RI, TN, 

UT, WA). Thirteen SMHAs are also investing 

funds in developing youth-specific and/or inhome crisis stabilization services (ID, IA, LA, 

ME, MA, MI, NE, NH, NJ, NY, OH, UT, WI). 

SMHAs also identified efforts to expand crisis 

services in school-based settings (CA, DC, ID, 

SD), divert children and youth from emergency departments (GA, ME, MO, VT), expand text and chat 

capabilities (AZ, NH, NJ, OR), and expand the crisis workforce for children and youth (AK, GU, LA), 

including an expanded use of children and youth-specific peers (KY, OR).

Crisis Services for Individuals Living in Rural and Remote Areas 

Twenty-nine states and territories (AL, AK, 

AR, CA, CT, HI, ID, IN, KS, KY, LA, MD, 

MI, MN, MO, NV, NH, NM, NY, NC, PA, 

SC, SD, TN, TX, UT, VA, WV, WY) 

identified efforts and needs related to 

improving services for individuals living in 

rural and remote areas of the U.S. in their 

2022/2023 MHBG applications, COVID-19 

relief plans, and/or ARPA plans submitted to 

SAMHSA (Figure 12). Eleven SMHAs (AL, 

CA, CT, KS, LA, MI, MO, NV, NY, SC, 

WV) are using funds to expand mobile crisis 

teams and thereby reduce the amount of time 

individuals in rural and remote areas are 

required to wait for services. Other efforts 

described in the funding plans include 

expanding crisis stabilization services in rural areas (HI, NV, NC, UT, WY), increasing telehealth 

capabilities to provide virtual mobile crisis response (ID, MN, NC, TN), encouraging collaborative 

relationships with primary care providers and other stakeholders to promote collaborative care for 

individuals in crisis in rural and remote areas (IN, KY, PA), and recruiting and training peers to respond 

to crisis situations (AL, AR). Many MHBG applications, COVID-19 relief fund plans, and ARPA plans 

Figure 11: SMHAs Identifying Crisis Services for 

Children and Youth in MHBG, COVID-19, and ARPA 

Plans

Figure 12: SMHAs Identifying Crisis Services in Rural & 

Remote Areas in MHBG, COVID-19, and ARPA Plans
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State Program Improvement TA Project 22

also noted that workforce shortages and transportation issues are big challenges in rural and remote areas, 

regardless of service methodology or need (e.g., crisis).

Crisis Services for Individuals with Co-Occurring Needs 

Twenty-six states and territories (CA, DC, 

FL, ID, KS, KY, LA, ME, MS, NE, NH, NJ, 

NM, NY, NC, ND, OK, OR, PR, RI, SC, SD, 

TX, VI, WV, WI) identified efforts and needs 

related to improving crisis services for 

individuals with co-occurring mental health 

and substance use needs in their 2022/2023 

MHBG applications, COVID-19 relief plans, 

and/or ARPA plans submitted to SAMHSA 

(Figure 13). Eight SMHAs (CA, KS, LA, MS, 

NE, ND, OR, PR) simply recognized that their 

crisis continuums serve individuals with cooccurring needs. Kansas included problem 

gambling as a co-occurring need. Nine 

SMHAs (FL, KY, NH, NJ, NY, OK, SC, SD, 

WV) identified efforts related to improving 

services within crisis stabilization units for individuals with co-occurring needs. Six SMHAs (ME, NH, 

NM, NC, SC, WI) are using funds to ensure their mobile crisis teams are responsive to individuals with 

co-occurring substance use and mental health needs. Four SMHAs (ID, ME, NY, RI) are ensuring that 

their crisis services are able to refer individuals with co-occurring needs to appropriate follow-up 

services. Two SMHAs (KY, RI) are implementing screening instruments to accurately determine an 

individual’s substance use needs and make treatment recommendations. Other activities are related to 

mental health, substance use, and co-occurring hotlines (TX); training the crisis workforce to better serve 

individuals with co-occurring needs (VI); and developing co-responder models (ME).

Crisis Services for Veterans and the Military 

Eleven states (CT, DE, IL, KS, KY, LA, MD, 

MI, NE, OH, OR) identified activities related 

to serving veterans and the military in their 

2022/2023 MHBG applications, COVID-19 

relief plans, and/or ARPA plans submitted to 

SAMHSA (Figure 14). Connecticut, 

Delaware, Illinois, Maryland, Ohio, and 

Oregon have suicide prevention efforts 

specific to veterans, and Michigan and 

Nebraska offer a Veterans’ Crisis Line. It is 

also common for SMHAs to partner with

other offices in the state, including their 

Governor’s Offices and the state Veterans 

Affairs agencies to make these campaigns and 

activities successful. Other crisis efforts 

related to veterans include training staff to be

Figure 14: SMHAs Identifying Crisis Services for 

Veterans and the Military in MHBG, COVID-19, and 

ARPA Plans

Figure 13: SMHAs Identifying Crisis Services for 

Individuals with Co-Occurring Needs
Snapshot of Behavioral Health Crisis Services and 

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State Program Improvement TA Project 23

culturally competent to veterans’ needs (KY), training and collaborating with primary care providers 

(MD), and enhancing Crisis Intervention Team training to be more responsive to veterans’ needs. 

Use of Technology to Deliver Behavioral Health Crisis Services

SMHAs identified efforts in their MHBG applications, COVID-19 relief fund plans, and ARPA plans 

related to the use of technology to enhance the delivery of crisis services. SMHAs are investing in GPSenabled technology to better collaborate with mobile crisis teams (AZ, AK, CA, GA, KS, MN, MO, NV, 

NC, TN); enhancing telehealth services to allow for virtual mobile crisis response (AK, AR, CT, DC, FL, 

ID, IN, MA, MN, NH, PA, SC, WV, WI); providing text and chat options to better engage entire 

communities in care, particularly youth and young adults who prefer communication via text messaging 

(AZ, CA, MS, NH, NY, OH, TN, VT); using real-time service registries to support efficient connections 

to needed resources (AZ, CA, CT, KS, LA, MS, MO, NE, NC, OH, WA); and using scheduling software 

to facilitate referrals to care, schedule follow-up appointments, and improve overall care collaboration 

(AZ, DE, MS, MO, NV, NH, NJ, NC, WI). SMHAs are also exploring ways to improve their information 

technology infrastructure, including expanding the availability of broadband, Wi-Fi, and cellular 

technology for providers in rural and remote areas (CA, ID, KY, MA, MN, NE, NM, CN, MI, ND, PA, 

SC, SD, TN, WV, WI). SMHAs are also investing in health information exchanges (AZ, CO, GA, ID, IL, 

IN, LA, MD, MI, MS, NE, OK, OR), electronic health records software (GU, KS, KY, LA, ME, MA, MI, 

MS, NH, TN, VA, WA) and other data collection and sharing technologies (VA, WV) to better 

understand their crisis systems, streamline care, and improve outcomes. Other uses of technology 

identified by SMHAs that enhance access to and the delivery of crisis services include the following: 

• Arkansas is equipping Emergency Medical Services vehicles with technology that provides 

instant access to behavioral health providers when responding to crisis situations. 

• Guam uses web-based interpreting services to facilitate communication.

• Puerto Rico is investing in technology responsive to the continuous evolution and adaptation of 

services to digital platforms. 

• Texas is investing in technology infrastructure to complement and enhance the behavioral health 

workforce, including peer support specialists. 

• The Virgin Islands is using technology to raise awareness about SMI and the available resources 

through different media outlets, including online newspapers, social media accounts, radio 

stations, and television. 

Use of Psychiatric Advance Directives in Crisis Prevention

Psychiatric advance directives describe an individual’s wishes in the event they are unable to express their 

desires for behavioral health care services and treatments. These are critical tools that enable individuals 

to be engaged in person-centered care during a psychiatric emergency or behavioral health crisis even if 

they cannot express themselves. The 2022 MHBG applications asked states to identify whether they use 

psychiatric advance directives in their crisis prevention and early intervention services. Forty-three 

SMHAs indicated in their MHBG applications that they do use psychiatric advance directives (Figure 15). 
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Figure 15: States Using Psychiatric Advance Directives in Crisis Prevention

Wellness Recovery Action Plans (WRAP) and Crisis Planning

Wellness Recovery Action Plans (WRAP) are strategic plans that help individuals with behavioral health 

needs maintain their emotional health and wellbeing. The 2022 MHBG applications asked states to 

identify whether they use WRAP as part of their crisis prevention and early intervention services. Fortyeight SMHAs indicated in their MHBG applications that they do use WRAPs as part of their prevention 

and intervention services. (Figure 16). 
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Figure 16: States Using WRAP in Crisis Planning

Use of Recovery Coaches and Partnerships with Recovery 

Community Organizations

Recovery coaches provide mentoring and support to individuals with behavioral health needs who are in 

the initial stages of recovery. Recovery coaches often have their own lived experience of recovery, and 

may be certified as a peer support specialist. Recovery coaches may be associated with formal recovery 

community organizations that bring together individuals in recovery to provide non-clinical services and 

supports that facilitate the recovery process. The 2022 MHBG application requested states to indicate 

whether they use recovery coaches and if they have relationships with recovery community organizations 

to support crisis prevention. Forty-two SMHAs indicated using recovery coaches, and 40 SMHAs 

identified partnerships with recovery community organizations (Figure 17).
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Figure 17: States Using Recovery Coaches and Partnering with Recovery Community Organizations

Availability of Same-Day and Follow-Up Appointments for Crisis 

Services

To continue engagement with the behavioral health system and prevent future crises, some SMHAs 

ensure that same-day and follow-up appointments are available to individuals experiencing a crisis. 

Nearly all SMHAs (55) indicated in their MHBG, COVID-19, and ARPA plans that they are able to make 

same-day and/or follow-up appointments for individuals (Figure 18), and 43 SMHAs indicated that their 

crisis systems are able to make referrals to appropriate services (Figure 19). 
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Figure 18: SMHAs with Ability to Make Same-Day and Follow-Up Appointments for Crisis Services
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Figure 19: SMHAs Able to Make Referrals for Post-Crisis Services

Limitations on Use of Crisis Services

To sustain the operation of crisis services, SMHAs may limit who can access the services based on ability 

to pay. Four SMHAs indicated access restrictions to specific crisis services in their MHBG applications 

and ARPA plans as follows: 

• In Connecticut, crisis stabilization beds for children and youth are only available to individuals 

currently involved with the Child Welfare division. 

• In Kansas, short-term respite care is available through the Serious Emotional Disturbance (SED) 

Waiver and provides temporary direct care and supervision for the participant. The primary goal 

of this service is to provide relief to the parents and/or caregivers of a participant with an SED. 

• Louisiana is actively developing crisis services and supports, including mobile crisis response, 

behavioral health crisis clinics, and community brief-crisis support for Medicaid-eligible adults. 

The eventual goal is for the services to be available to all, regardless of ability to pay.

• In Nebraska, individuals who are eligible for Medicaid benefits have access to other crisis 

interventions, including Crisis Therapy, that non-Medicaid beneficiaries may not be able to 

access.
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Summary 

All states recognize the critical importance of the three primary components of a crisis care system, as 

delineated in SAMHSA’s National Guidelines: crisis call centers, MCTs, and crisis receiving and 

stabilization services. Due to the launch of the Lifeline nationwide, states gained access to resources and 

guidance that enabled them all to operate crisis call centers. There are now more than 180 Lifeline call 

centers, with 16 more planned.50 Beyond the Lifeline system, many states continue to operate additional 

crisis call systems that served over 1.7 million people last year. Eighty-eight percent of states surveyed 

provide mobile crisis teams and 57 percent provide crisis receiving and stabilization services. Among 

states not currently operating mobile crisis teams, all indicated that they are working to establish teams. 

SMHAs also identified efforts to improve and expand crisis services to special populations, including 

LGBTQI+ individuals, racially and ethnically diverse communities, older adults, children and youth, 

Native American/Alaska Natives, and those living in rural and remote communities. To better serve these 

special populations, most SMHAs are focusing efforts on training and diversifying their crisis workforce 

to be more representative of those they serve. 

States face several major barriers in the implementation of a crisis care system.51 One of the largest is the 

lack of available workforce, which makes it difficult to keep crisis call centers, MCTs, and crisis 

stabilization services operating 24/7, especially overnight and over the weekend. Workforce shortages are 

especially acute in rural areas, where states also face other barriers to providing access to crisis services, 

including the long distances MCTs must travel and a lack of nearby CSUs and short-term CRPs. 

States also indicate that funding is an issue for crisis services. Although the 5 percent crisis services setaside has brought a welcome influx of funds, it does not cover the cost of a statewide, 24/7 crisis care 

system. States are using additional MHBG funds, state general funds, Medicaid (particularly for MCTs), 

and other sources.52 Several have recently implemented a Lifeline fee that will be applied to every phone 

line within the state (see Table 2: Number of States Using Specific Funding Sources to Support 

Behavioral Health Crisis Services, 2022). The development of new funding streams, whether a phone line 

fee or the ability to bill private insurance and Medicaid enough to cover the crisis services, will be critical 

for the sustainability of the crisis care system. 

The U.S. Territories and Pacific jurisdictions face especially acute challenges to establishing crisis care 

systems as delineated in the National Guidelines. They do not have sufficient local resources to fund a 

crisis system, and the amount provided by 5 percent set-aside funding is not enough to cover crisis service 

provision, let alone set up a crisis call center or MCT. Beyond the problem of resources, the distance 

between islands forms a tremendous barrier among the Pacific jurisdictions to providing timely care via 

MCTs, CSUs, or other modalities.

States have identified a variety of TA needs in their MHBG applications and through discussions with 

NASMHPD that include:53

• Needing to share information and to coordinate responses between 911 and 988 

• Providing mobile crisis services in rural and remote areas

• How to fund in-home crisis stabilization for youth

• How to effectively bill Medicaid for crisis services without violating the IMD exclusion 
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Appendix A: Examples of 911 Decision Trees
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Figure 20: Didi Hirsch 911 Call Diversion Flow54
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Figure 21: Broome County, NY’s 911 Call Diversion Emotionally Distressed Caller Risk Assessment55
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Appendix B: Efforts by SMHAs for Special Populations Identified in 

their MHBG, COVID-19 Relief Funds, and ARPA Plans
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Each of the activities described in this appendix are taken from SMHA submissions to their 2022/2023 

MHBG applications on SAMHSA’s WebBGAS system, from their COVID-19 relief plans, and/or from 

their ARPA plans. 

Activities Identified to Improve Crisis Services for LGBTQI+ Individuals: 

• Colorado is using COVID-19 relief funds to support one-time projects in identified service gaps 

for transition-aged youth (ages 16-25) who identify with one or more marginalized identities, 

including LGBTQI+. 

• Connecticut is working with a consultant to identify the unique service needs of LGBTQI+

individuals. The consultant will then develop and deliver a training to the SMHA providers who 

are working with individuals with SMI in the LGBTQI+ community.

• Hawaii’s SMHA recognized in its ARPA plan that LGBTQI+ individuals may be at a higher risk 

of being victims to human trafficking, acknowledging that specialized services are needed related 

to this population.

• Kansas is using its SAMHSA TTI Grant to work with community partners to identify the specific 

individual needs of all LGBTQI+ individuals in the state by providing competent, evidence-based 

training. Highly trained, culturally competent staff and peer support professionals will be able to 

ensure services received through 988 are accessible to and inclusive of LGBTQI+ individuals 

experiencing suicidal ideation or a mental health crisis.

• In Kentucky, crisis staff are being trained to provide culturally responsive services to those 

identified as high risk, including LGBTQI+. The SMHA is using COVID-19 relief funds to 

provide targeted outreach to underserved and vulnerable populations, including those most at risk 

for health disparities due to race, ethnicity, gender, or sexual orientation. 

• Massachusetts is using COVID-19 relief funds to support Young Adult Access Centers that 

provide culturally responsive settings for LGBTQI+ youth and other under-served populations. 

The Commonwealth is also using ARPA funds to provide culturally competent services to 

individuals who identify as LGBTQI+, including transgender, non-binary. 

• Michigan’s SMHA plans to use ARPA funds to augment peer outreach to underserved 

communities, including those within the LGBTQI+ community. The state is also tracking the 

demographics of who uses crisis centers, including those who identify as LGBTQI+. 

• New Jersey’s SMHA plans to increase outreach, treatment, and services to LGBTQI+ individuals 

to ensure that services are delivered in a culturally competent manner. Additionally, outreach will 

be extended to address the needs of the acute care service system and enhance mobile outreach 

services for LGBTQI+ individuals. 

• New Mexico is using COVID-19 relief funds to enhance outpatient behavioral health services for 

LGBTQI+ individuals with an SED/SMI diagnosis. 

• Oregon reported in its MHBG application that it is developing crisis response strategies for 

working with LGBTQI+ individuals who are at a higher risk of suicide. The SMHA is also using 

ARPA funds to support trainings for providers that focus on how to better meet the needs of 

underserved communities, including LGBTQI+ individuals.

• Palau’s SMHA is allocating some COVID-19 relief funds to an LGBTQI+ organization to better 

meet the needs of individuals within the LGBTQI+ community with mental health needs. 

• Puerto Rico is using MHBG funds to support crisis hotline services for individuals within the 

LGBTQI+ community. 

• The U.S. Virgin Islands acknowledges that individuals within the LGBTQI+ community will be 

served by ARPA funds. 
Snapshot of Behavioral Health Crisis Services and 

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• Utah’s SMHA is using ARPA funds to partner with community agencies that provide peer 

support and case management care to marginalized populations, including those in the LGBTQI+

community, and those who are in plural marriage arrangements.

• Virginia is using COVID-19 relief funds and ARPA funds to develop and continue training-thetrainers for specialized LGBTQI+ peer and family support specialists to better serve this 

community. 

• Washington’s SMHA is using COVID-19 relief funds and ARPA funds to ensure training? is 

offered to diverse clinician groups, including LGBTQI+ providers. 

Activities Identified by SMHAs to Improve Crisis Services for Racially and 

Ethnically Diverse Communities: 

• Arizona indicated in its COVID-19 relief and ARPA plans that it will use funds to address the 

mental health needs of individuals in the juvenile justice system to reduce the risk of recidivism 

for racial and ethnic minoritized communities. 

• Connecticut’s SMHA plans to use COVID-19 relief funds in New Haven and Hartford for 

agencies working primarily with Hispanic and African American individuals with SMI.

• Kansas’s SMHA is part of the Mobile Response and Stabilization Services (MRSS) Quality 

Learning Collaborative through the Institute for Innovation and Implementation at the university 

of Maryland. MRSS plays a critical role in preventing future crises, and reducing involvement 

with law enforcement, particularly for children and youth who are Black, Indigenous, and persons 

of color. The SMHA also recognized in its ARPA plans that specific minoritized communities, 

including African Americans, American Indian/Alaska Natives, and Native Hawaiians/Other 

Pacific Islanders are over-represented in mental health services in comparison to their Kansas 

population totals. 

• In Kentucky, crisis staff are being trained to provide culturally responsive services to individuals 

identified as high risk, including Black, Indigenous, People of Color. To address the health 

disparities and need? to outreach and engage underserved and vulnerable populations, the SMHA

has hired an Executive Advisor to the Commissioner and created a variety of workgroups to bring 

together expertise and resources to address racial and ethnic disparities specific to behavioral 

health. Targeted outreach to underserved and vulnerable populations, including those most at risk 

for health disparities due to race and ethnicity.

• Maine’s SMHA directly funded BIPOC-led agencies that employ Community Health Workers to 

provide stress management and resiliency supports to residents, with a particular focus on 

immigrant, refugee, and asylee communities and non-native English speakers, as well as Native 

populations, Latinx communities, and Black Americans. These affirmative efforts have been in 

tandem with other state efforts to better support non-white communities.

• In its ARPA plans, Massachusetts’s Department of Mental Health indicates that it is committed to 

serving the needs of persons living with SMI or SED, including BIPOC and/or Latinx 

individuals. 

• Minnesota’s SMHA is using ARPA funds to train BIPOC-licensed clinicians in early childhood 

mental health. BIPOC Trainees Early Childhood Staff will collaborate with Cultural and Ethnic 

Minority Infrastructure Grant (CEMIG) Program to train and support licensed clinicians of color 

to provide affinity groups to early childhood mental health clinical trainees throughout the state. 

With this funding, it is estimated that the CEMIG grantees may operate up to five ongoing 

affinity groups per year for up to 50 childhood clinicians and clinical trainees. 
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• Nebraska’s SMHA is using COVID-19 relief funds to implement the CLAS/Health Equity 

Evaluation Tool, Program, and Curriculum to reinforce previous efforts to improve Culturally and 

Linguistically Appropriate Services (CLAS) and promote health equity in behavioral health 

programs. The SMHA also indicated that it will use ARPA funding to provide funds to integrate 

behavioral health clinicians and/or peer support specialists in Federally Qualified Health Centers 

(FQHCs) or other primary care settings and for training and consultation to address disparities, 

increase diversity and health equity through cross-system engagement, planning and 

implementing strategies to strengthen a competent behavioral health workforce which is racially, 

ethnically, and linguistically diverse to improve engagement of communities of color for SED 

and SMI services.

• Nevada indicated in its ARPA plan that it is projected to become a minority-majority state by this 

year (2023), noting that this shift requires approaches that are culturally and linguistically 

appropriate to improve access to care for all populations. The SMHA also notes in its COVID-19 

relief plan that potential barriers to access for diverse populations include structural disadvantages 

(e.g., socioeconomic) and cultural inequalities (e.g., racial-ethnic group membership).

• New Jersey’s SMHA plans to increase outreach, treatment, and services to racially and ethnically 

diverse individuals to ensure that services are delivered in a culturally competent manner. 

Additionally, outreach will be extended to address the needs of the acute care service system and 

enhance mobile outreach services for these communities. Specific communities identified include 

Muslim, Haitian, African Americans, and indigenous populations. 

• New Mexico indicates in its ARPA plan that service delivery in the state always considers the 

disproportionately high rates of SMI and SUD in certain communities, especially in Native 

American and Hispanic populations. 

• North Carolina is increasingly focusing efforts on disparities, which requires the evaluation of 

existing services and policies to identify bias and prejudice. Programs, services, and policies need 

to be developed that will address racial disparities within the state with respect to mental health 

and access to appropriate services. 

• Ohio is prioritizing access to care with the ultimate goal of improving behavioral healthcare 

outcomes for racially and ethnically diverse communities who are often underserved. 

• Oregon’s Health Authority established the Crisis System Advisory Workgroup (CSAW) which 

was established to listen, learn, and understand how marginalized populations, especially BIPOC 

communities, would want to experience a crisis response when they call 988 or receive crisis 

response services. CSAW has included the following representation: individuals and families 

with lived experiences, including those from BIPOC communities. In addition, Oregon’s SMHA

indicated in its ARPA plans that it is using the funds to develop and distribute toolkits, written 

handbooks, and interactive trainings for behavioral health providers, created and delivered by 

people with lived experience. These trainings focus on how to better meet the needs of 

marginalized and/or underserved communities, including POC. 

• Pennsylvania indicates in its COVID-19 relief plans that it will use the funds to allow counties to 

expand the use of telehealth service delivery for behavioral health services in rural and 

underserved minority and immigrant communities to address existing inequities in access to 

healthcare.

• Puerto Rico provides crisis services in multiple languages to meet the needs of diverse 

communities, including English, Spanish, and American Sign Language. Puerto Rico is also 

developing community-based programs designed to strengthen clinical services for minoritized

populations and residents of low-income communities.
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• Rhode Island is attempting to reduce disparities and promote equity through the implementation 

of student assistance counselors in all middle and high schools, prioritizing those schools that 

serve diverse racial and ethnic communities.

• Utah is focusing its COVID-19 relief funds on culturally and linguistically responsive services 

focusing on cultural and racial disparities and the linguistic needs for non-English speaking 

individuals, including for individuals who are deaf and hard-of-hearing. In 2020, Utah Strong 

crisis counselors served nearly 90,000 individuals, providing services in five separate languages, 

including Spanish and Navajo. 

• Virginia is using COVID-19 relief funds to establish a network of crisis providers, researchers, 

and racial and justice-focused behavioral health organizations to establish trainings, 

memorandums of understanding, analyses, and other needs to ensure there is robust 

representation and relationships between the regional mobile crisis hubs and Black-led, peer-led, 

and BIPOC-led crisis services networks. Additionally, the State is using ARPA funds to develop 

infrastructure to divert behavioral health emergencies away from 911 towards 988 through the 

development of cooperative agreements between law enforcement, the expansion of mobile crisis 

teams, the development of community care teams (which may or may not include law 

enforcement), and the creation of a specialized law enforcement response for when they are 

called to serve a behavioral health crisis.

• Washington indicated in its ARPA plans that all programs supported by the funds will be 

designed and delivered in a manner sensitive to the needs of all ethnic minorities. Crisis sites will 

initiate actions to ensure or improve cultural relevance of services for ethnic minorities and other 

diverse populations that are typically underserved and marginalized in the system. CLAS 

standards are required for all programs, and the SMHA will promote diversity, equity, and 

inclusion and provide specific outreach to BIPOC communities, as well as employ staff that 

represent the population served by the state, ensuring health equity through policy, practices, and 

resources. The SMHA also indicated that COVID-19 relief funds will be used to support the 

Foundational Community Support program, which is based on the Permanent Supportive 

Housing and Individual Placement and Support models. These principles of these practices 

encompass equity and racial justice through the promotion of choice, flexible voluntary services, 

and access. This project will support a statewide community-based mental health engagement and 

service delivery system that acknowledges individual and institutional bias have marginalized 

members of the communities.

• Wisconsin acknowledged in its COVID-19 relief plans the need to support historically 

underserved communities in its crisis services system, and will do so through the implementation 

of a statewide warmline run by peers that will support diverse populations across the state who 

identify as Latinx, Black, or Hmong

• Wyoming noted in its MHBG application a priority to improve services for racially and ethnically 

diverse communities. 

Activities Identified to Improve Crisis Services for Older Adults 

• In its MHBG application, Colorado noted that fewer older adults sought in-person crisis services 

during the pandemic. The SMHA also indicated in its COVID-19 relief plan that it has enhanced 

outreach and referral processes to ensure access to information about the consequences of 

substance use is available to all groups, including older adults. 
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• Maine’s ARPA plan indicates that the SMHA is providing Mental Health Intensive Outpatient 

Comprehensive Services, which are high-intensity services to avoid hospitalization and offer 

step-down care that provide focused programs for a variety of populations, including older adults. 

• Maryland’s SMHA noted in its COVID-19 relief plan that it would like to provide wrap around 

services for older adults. The SMHA is also planning an Intervention Recovery and Support 

program that allows for the continuation of the provision of Family Peer Support and Navigation 

services to families of adult loved ones, including older adults, with a mental health 

challenge/concern or disorder.

• Through its ARPA funds, New Jersey is supporting PEARLS (Program to Encourage Active, 

Rewarding Lives for Seniors). PEARLS is a home-based setting via an outreach program that 

utilizes a social worker to provide eight sessions of problem-solving treatment over a 19-week 

period combined with increased participation in activities that the individual finds enjoyable. 

Staffing of the program includes a consulting psychiatrist, LCSW or LPC, and ideally 

collaboration with the individual’s primary care physician. 

• New York’s Office of Mental Health is looking to expand workforce training opportunities, 

including the training of law enforcement on diversion techniques, to best support special 

populations, including older adults with mental illnesses. 

• North Carolina indicated in its ARPA plan that it is expanding access to prevention treatment 

services and older adult specialty peers.

• Ohio’s SMHA is engaged in a Senior Vulnerability and Density Mapping Project to better serve 

older adults with SMI. 

• Oregon is developing crisis response strategies for working with older adults.

• The Republic of the Marshall Islands acknowledged that its crisis system strives to meet the 

behavioral health crisis needs of older adults in its ARPA plans.

• The Virgin Islands Department of Human Services offers a series of social services to enhance 

the quality of life for individuals and families with diverse needs, including older adult protection 

services.

• Virginia is implementing the Certified Older Adult Peer Specialist Program, which is designed to 

train peer specialists as older adult behavioral health specialists and wellness coaches.

• Washington’s SMHA is using COVID-19 relief funds to develop a curriculum for a 100-hour 

course for mental health professionals to secure credentials to become focused providers, 

including Older Adult Mental Health Specialists.

Activities Identified to Improve Crisis Services for Native Americans and 

Alaska Natives

• Alaska’s SMHA is working with the tribal health system and providers to deliver crisis services. 

IT is challenging, as many Alaska Native and American Indian communities do not have roads 

that connect to nearby villages. Typically, the only way to travel in and out safely is by plane or 

water. Due to the state’s vast geography, Alaska has struggled to embrace crisis services in every 

community, which has resulted in children and youth in crisis being transported hundreds of 

miles away from their homes, families, and cultural traditions.

• Arizona’s regional behavioral health authority contractors must provide the full range of crisis 

services on tribal lands as dictated by each tribe within their region. There must also be a process 

in place where tribal liaisons and appropriate clinical staff coordinate crisis services on tribal 

lands with tribal providers. 
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• Colorado is using ARPA funds to provide Ute Mountain Ute first responders with mental health 

awareness training and crisis mitigation outreach peer services. The SMHA is also supporting 

peer service expansion with crisis mitigation outside the reservation areas, where most of the 

Native American/Alaska Native population live. 

• Kansas’s SMHA has been given the opportunity to be part of the Mobile Response and 

Stabilization Services Quality Learning Collaborative, which plays a critical role in preventing 

future crises for a variety of specific populations, including indigenous individuals.

• In Maine, the Wabanaki Care Line and multiple tribal domestic lines supplement the crisis 

services offered by the SMHA. 

• Michigan is developing the Michigan Crisis and Access Line in partnership with tribal 

communities and other stakeholders.

• Montana is providing enhanced training and TA to healthcare providers, including Tribal Health 

programs to assess for depression, mental health wellness, and substance misuse.

• Nevada is working with Tribal populations to expand Mental Health First Aid, postvention 

training, and county-specific interventions.

• Community partners in North Carolina, including Tribes, are providing guidance on the 

development and implementation of services provided through the SMHA. 

• In New Mexico, the Crisis Now continuum of services was designed with input from Tribal 

communities. COVID-19 relief funds and ARPA funding will be used to expand outpatient 

behavioral health services for Native Americans.

• North Carolina is developing and piloting culturally adapted models of care for Native Americans 

to increase awareness around mental health and first episode psychosis.

• Oregon is collaborating with Tribal communities to raise awareness and increase training around 

first episode psychosis.

• Puerto Rico is allocating some COVID-19 relief and ARPA funds to one Tribal community for 

the purpose of planning, implementing, and evaluating the needs of the communities to prevent 

and treat substance use disorder.

• South Dakota is using its COVID-19 relief funds to increase services to Native Americans, the 

state’s leading minority population.

• Utah-Strong counselors served nearly 90,000 individuals in 2020, showing strong demand for 

these services, with services offered in five separate languages, including Navajo. 

• Washington’s SMHA is providing training and support to crisis providers through its MHBG, 

with a focus on providing culturally appropriate services and effective coordination of care and 

discharge planning for Native American/Alaska Native clients receiving crisis treatment. 

Additionally, the state is using COVID-19 relief funds to support a statewide community-based 

mental health engagement and service delivery system that acknowledges that individual and 

institutional bias have marginalized members of the state’s communities. The funding enhances a 

system that works toward equity and inclusion, and recognizes that Native American/Alaska 

Native populations have distinctly unique needs and expectations, and that engagement and 

treatment services are strategically implemented and culturally relevant. The Health Care 

Authority will contract with 29 federally recognized Tribes and two Urban Indian Health 

Organizations to deliver needed mental health services to adults and youth with SMI/SED to 

prevent, prepare for, and respond to behavioral health gaps within their tribal communities. 

• Wisconsin allocated COVID-19 relief funds to counties and Tribal communities to purchase PPE 

for clients and staff to ensure in-person work and services can continue to be conducted safely. 
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Activities Identified to Improve Crisis Services for Children and Youth 

• Alabama is using ARPA funds to expand Mental Health First Aid Train the Trainer for children, 

youth, and adults.

• Alaska is using MHBG funds to support the development of youth-focused mobile crisis teams. 

In its ARPA plans, the SMHA also indicated that it is focusing funding to develop the workforce 

to work with youth ages 16-24 who are experiencing homelessness and at risk for victimization, 

and to help them access emergency behavioral health services and work with first responders to 

support referrals to services. These positions will also provide referrals to crisis stabilization 

services, as well as offer access to medical services, clothing, and shelter referrals.

• Arizona is prioritizing text and chat capabilities for 988 that have shown to be popular among 

teenagers and young adults. 

• California indicated in its MHBG application that all SMHA-funded Crisis Care Mobile Units 

must prioritize services to individuals 25 and younger, which may include activities such as 

conducting needs assessments for youth services, placing mobile units near schools and 

universities, providing outreach and public education campaigns, and taking measurable steps 

towards addressing the youth and young adult crisis needs within the community. California also 

indicated that the SMHA is allocating funding to counties, behavioral health agencies, and joint 

groups of counties or city behavioral health agencies to provide services to individuals, 

particularly children and youth, experiencing behavioral health crises.

• Connecticut’s Department of Children and Families handles crisis services for children, including 

the ACTION crisis hotline, and mobile crisis teams specifically for youth. Youth mobile crisis 

teams are required to respond to 90 percent of calls face-to-face, and 80 percent within 45 

minutes. The Department of Children and Families was also part of a coalition to develop the 

state’s plans for 988.

• Youth crisis services in Delaware are provided by Delaware Guidance, which is not part of the 

Lifeline network. The state indicated in its COVID-19 relief plans that Respite Services will 

expand the network of trained respite providers to assist youth and families with SED with shortterm respite services as an alternative to increased use of crisis beds and reduce out-of-house 

placements. COVID-19 limited bed capacity while need increased, and equipping providers to 

manage challenging behaviors and would allow for these youth to be better served short-term 

outside of a facility. Family peer supports will be expanded to provide services to youth/families 

with SED to avert the need for more intensive behavioral health services later by providing early 

supports to the stressors and the limited community supports imposed by COVID restrictions. 

The state is developing an awareness campaign using print and digital media to educate youth and 

families with SED about services and supports available through the Department. In its ARPA 

plans, Delaware indicated that the Department of Children, Youth, and Families will use the 

funding to enhance the expansion of crisis response services. 

• The District of Columbia operates a separate mobile crisis team for children and youth, ages 6-21, 

called the Children and Adolescent Mobile Psychiatric Service (ChAMPS). In addition, the 

SMHA also has school mental health services, which includes a crisis component to respond to 

school-based crises related to trauma, death, and other crises.

• Georgia indicated in its ARPA plans that the Morehouse School of Medicine (MSM) Child and 

Adolescent Psychiatry Fellows will provide culturally informed psychiatric diagnosis and 

treatment to youth with SED participating in community-based programs. Fellows will also 

provide consultation to pediatricians and hospital emergency departments where youth with SED 
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are presenting in psychiatric crisis, and will also explore opportunities to consult with mobile 

crisis teams.

• Guam is recruiting counselors, therapists, care coordinators, key family contact coordinator, 

youth coordinators, and mental health peers to provide outreach and crisis services for the 

SED/SMI population. 

• Hawaii has a separate mobile crisis outreach program for youth. The State is also using COVID19 relief funds to build capacity for emergency departments to disposition youth and adults in 

crisis by funding telepsychiatry services for youth on neighbor islands to expedite their time in 

the hospital. 

• Idaho offers flexible funds that can be used for crisis stabilization or to assist youth and family by 

providing one-time or occasional goods or services (e.g., food, lodging) that may mitigate the 

identified crisis. Through the COVID-19 relief funds, more schools will be able to join the annual 

cohort of schools in the Idaho Lives Project, which provides resources to implement evidencebased youth suicide prevention programs. Idaho also indicated in its ARPA plans that children 

and youth with SED and their families can access crisis services and/or supports through crisis 

call lines, mobile crisis response, and crisis beds for crisis respite. Each of the seven regions has 

CMH-trained staff available to provide crisis support by phone.

• Indiana is using COVID-19 relief funds to support a hotline for youth in rural communities.

• Iowa is using MHBG funds to develop more facility-based crisis service options for children.

• Kansas’s Department for Children and Families has a Family Crisis Hotline that is provided 

through Beacon Health Options. This hotline provides crisis response services through a 24/7 

hotline for any family with a child under 18, and/or for youth who are in or were in foster care 

and are under the age of 21. This service is available to all, regardless of ability to pay.

• Kentucky’s SMHA offers youth peer support programming, which was designed through a 

collaborative process with the goal of improving the crisis services system. The state also plans to 

increase the capacity of its crisis response safety net to appropriately respond to behavioral health 

crises of adults, youth, young adults, and their families across the state. 

• Louisiana provides crisis services to children and youth and their families, including crisis 

stabilization services. With the COVID-19 relief funds, the State will provide training to enhance 

mental health treatment response for youth with SED through training staff and leadership of 

provider agencies, including crisis response.

• In Maine, each district is required to provide up-to-23-hour observation for transition-aged youth. 

A multidisciplinary team comprised of peers, nursing staff, and clinical oversight provide 

therapeutic interventions, diagnoses, and stabilization. Community Behavioral Health programs 

also piloted Intensive Crisis After Care, providing MHRT-CSP and clinical support in the family 

home post-crisis episode. The goal of the pilot was to move youth that were waiting in EDs for 

placement in inpatient psychiatric units/residential care to their home and provide an intensive 

level of support to the family in their natural environment. In addition to moving children from 

EDs, the service kept families from seeking that level of involvement during a crisis; instead, they

called the after-care clinician who immediately met with them to help with their crisis. Families 

were taught the skills to effectively manage their youth’s crisis. The pilot is expanding, and the 

Crisis Center began serving transition-aged youth (14-17) in March 2022. The utilization for this 

age group is very low, with the Crisis Center reportedly only serving one youth per month since 

February, but each month there are multiple visits. Families are taught the skills to effectively 

manage their youth’s crisis, and the pilot expanded from one district to a full statewide rollout, 

and its continuation is being supported by ARPA funds. Overall, families report being very 
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satisfied with the service and the CASii assessment tool utilized at intake and discharge indicate 

that youth make gains, with most scoring in a lower level of care than their initial assessment.

• Massachusetts provides Mobile Crisis Intervention for youth, as well as crisis beds for youth 

through youth community crisis stabilization programs. Crisis flexible support teams also provide 

up-to 90 days of intensive, in-home therapeutic support to youth and families to help stabilize an 

acute behavioral health crisis and prevent the need for an out-of-home treatment intervention.

• When Michigan’s SMHA reorganized in March 2022, it created a Crisis Services Section which 

is leading work on developing a crisis system for all Michiganders based on SAMHSA’s National 

Crisis Services Guidelines. This Section is working closely with other staff to implement services 

for youth, including mobile crisis for youth which is being implemented by the new Children’s 

Bureau and the Diversion Fund grants. Through its Medicaid program, the state also provides 

intensive crisis stabilization services for adults and children for enrolled beneficiaries.

• Mississippi is using MHBG funds to establish 28 additional crisis stabilization beds for children 

and youth.

• Missouri’s Youth Emergency Room Enhancement program is expanding its scope to transition 

youth from hospital or vulnerable settings to community care. These individuals have significant 

behavioral health needs, are ages 6-17, and not engaged in community behavioral health care. 

Individuals engaged in this program will typically be experiencing escalating behaviors that, 

without immediate intervention, may require a higher intensity and duration of services. This 

program seeks to increase timely connections to behavioral health and family support services, 

address social determinants of health needs, and diminish barriers to youth and family 

engagement in services. The Department of Mental Health also supports an Access Crisis 

Intervention Mobile Crisis Pilot in which the community mental health providers partner with the 

Children’s Division, allowing workers access to mobile crisis teams and family support providers 

for children placed in relative kinship placement.

• Nebraska has expanded its services to include a Youth Mobile Crisis Response Service, which is 

designed for youth and adolescents. These teams provide immediate crisis counseling to those in 

need in the community. Youth Mobile Crisis may partner with law enforcement to assist with risk 

assessment, provide crisis intervention, crisis stabilization, and refer families to health resources 

in their communities.

• Nevada is expanding its mobile crisis response for children in both the northern and southern 

areas of the state through MHBG funds. Additionally, the Department of Children and Families 

will be working to support the crisis continuum and access of care for youth and adolescents in 

crisis to develop a youth triage unit in an emergency room to support youth and families and to 

divert from less-appropriate locations of services, including medical emergency rooms. The state 

is also looking at strategies to expand the psychiatric access line for youth.

• New Hampshire’s Rapid Response System provides easy access to behavioral health care for 

children, youth, adults, and families in crisis through phone, text, chat, community, office, and 

telehealth service modalities. The SMHA is also expanding in-home crisis stabilization services 

for children and youth with SED through ARPA funds.

• New Jersey’s Mobile Response and Stabilization Services are designed to help families stabilize 

youth in home and community settings. These services are available 24/7, 365 days-a-year and 

provide immediate (within one hour) interventions designed to minimize risk, maintain youth in 

their current living situations, prevent repeated hospitalizations, stabilize behavioral health needs, 

and improve functioning in life domains, including school and home routines. Mobile Response 

and Stabilization Services deliver services to youth who are vulnerable, experiencing stressors, 
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coping challenges, emotional and/or behavioral symptoms, difficulties with substance use, and/or 

traumatic circumstances that may compromise the youth’s ability to function optimally and thrive 

within their family/living situation, school, and/or community environments. In addition, New 

Jersey also offers 2NDFLOOR, a confidential call/text helpline and message board platform for 

youth and young adults. Youth who contact 2NDFLOOR are assisted with their daily life 

challenges by professional staff and trained volunteers. The State also has a New Jersey Youth 

Suicide Prevention Advisory Council that is comprised of appointed New Jersey citizens and 

state government representatives. This Council examines existing needs and services and makes 

recommendations for youth suicide reporting, prevention, and intervention.

• In New Mexico, the Children, Youth, and Families Department has begun working to establish 

mobile crisis response services in different parts of the state to respond to children and family 

crisis needs. The Behavioral Health Services Division has also entered into discussion with 

agencies in southern New Mexico to determine the feasibility of mobile crisis services that utilize 

credentialed and certified behavioral health professionals with independent behavioral health and 

medical staff on call.

• New York’s Children’s Health and Behavioral Health Medicaid System Transformation multiagency workgroup created services to address the behavioral health crisis needs for children and 

youth. The Office of Mental Health provides funding for services to provide support and 

stabilization in the community through Crisis Intervention Team training and home-based crisis 

intervention services for children, youth, and families. Residential Crisis Support, Intensive Crisis 

Residence, and Children’s Crisis Residence. Crisis residential programs are part of an expanding 

continuum of care in communities. They are designed to provide voluntary, short-term (up to 28 

days) interventions to individuals experiencing behavioral health crises; there are currently eight 

children’s crisis residences in operation.

• The Commonwealth of the Northern Mariana Islands offers a specialized children and youth 

mental health clinic, which responds to all non-suicide risk crises involving children and youth 

and their families.

• Ohio’s Medicaid Managed Care Plan is increasing crisis capacity and infrastructure to develop, 

evaluate, and expand crisis stabilization for a variety of populations, including children and 

families, in a variety of settings. The State is also expanding Mobile Response and Stabilization 

Services, a model that includes structured, face-to-face comprehensive treatment intervention and 

support services for youth ages 0-21. The State is also investing in Open Bed’s crisis module to 

support up to 60 crisis teams statewide, including teams for children and youth.

• Oklahoma’s SMHA operates statewide Children’s Mobile Crisis Teams for youth and young 

adults up to age 25 who are experiencing behavioral health or psychiatric emergencies.

• One of the National Suicide Prevention Lifeline sites in Oregon has been and continues to 

provide text services through the Youthline, which is focused on youth and young adults 

experiencing suicidal thoughts. Mobile Crisis Response is also available for children and youth, 

and may include the use of certified family and youth peer specialists.

• Palau offers crisis services for children and those at risk for maltreatment.

• Pennsylvania’s SMHA offers mental health crisis intervention services for children, youth, and 

their families who exhibit an acute problem of disturbed thought, behavior, mood, and/or social 

relationships that are immediate, crisis-oriented, and designed to ameliorate and resolve 

precipitating stress. The State also has the Garrett Lee Smith Youth Suicide Prevention grant that 

is working to improve continuity of care across youth-serving systems using the Zero Suicide 

framework. 
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• Puerto Rico offers crisis hotline services for youth and young adults, ages 13-24. 

• Rhode island is revamping mobile crisis services for children, and has issued a request for 

proposals to address mobile response for the children’s system. There is also a coordinated effort 

between the SMHA and the Department of Health on the youth suicide initiative. 

• In South Carolina, crisis clinicians provide youth with clinical screening to de-escalate crises and 

provide linkages to ongoing treatment and other resources. 

• South Dakota’s SMHA offers 24/7 crisis care services that support screenings and assessments of 

children and youth. The SMHA is also supporting increased access to behavioral health 

professionals in schools for youth in crisis and in need of ongoing supports.

• Tennessee’s crisis continuum includes children and youth mobile crisis response. The SMHA

contracts with 13 community behavioral health providers to operate adult and youth mobile crisis 

services that are non-hospital, community-based services. Children and youth mobile crisis 

services are provided to children and youth who are 17 years of age or younger. Four youthfocused mobile crisis teams cover the entire state, inclusive of Tennessee’s 95 counties.

• Utah has expanded youth and family crisis stabilization and mobile response services into several 

previously underserved multiple new areas, further increasing access to services for children, 

youth, and families. Youth-specific crisis programming is now being provided in all but two 

counties of the state.

• Vermont is investing its COVID-19 relief funds in hospital diversion programs to reduce youth 

boarding in the ED.

• Washington’s SMHA is in the process of expanding mobile crisis teams around the state and 

ensuring there is at least one adult and one youth team in each region. Crisis hotline services and 

face-to-face crisis services are available to all ages on a statewide basis.

• West Virginia’s First Choice Services is the call center for several complementary lines 

supporting youth and adult mental health. The state also has a substance use helpline, Help4WV, 

which links people of all ages with behavioral health services. 

• Wisconsin’s SMHA funds four youth crisis stabilization facilities where youth can be placed on a 

voluntary basis to de-escalate a mental health crisis. Some counties have youth beds available, 

and there will likely soon be authority for the state to license a small number of youth crisis 

stabilization facilities.

Activities Identified to Improve Crisis in Rural and Remote Areas 

• Alabama is using MHBG funds for five rural providers to implement rural crisis plans. The 

SMHA worked directly with these five providers to provide technical assistance and guidance 

with this process to ensure program development was connected to the statewide crisis system of 

care redesign and tailored to the needs of their particular rural communities. Common in all 

designs was that mobile crisis teams include co-response with law enforcement and certified peer 

specialists. ARPA and COVID-19 funds are also being used to implement two additional rural 

mobile crisis response teams.

• Alaska is using MHBG funds to support the Rural-Remote Emergency Program services to 

provide behavioral health crisis services in rural and remote areas of the state.

• Arkansas is using ARPA funds to support crisis services in rural and underserved areas of the 

state by providing funding for peer recovery support teams to respond to individuals in crisis.

• California is increasing efforts to establish and provide a standardized statewide system of mobile 

crisis units. These efforts include ensuring California minimizes the gaps in resources that 

smaller, rural counties may experience compared to larger counties to ensure individuals 
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throughout the state have access to appropriate levels of services. Rural communities are among 

the most challenging for California’s current crisis system to reach due to limited transportation 

and a lack of availability of treatment services.

• Connecticut indicated in its MHBG application that mobile crisis teams are supposed to reach 

people in rural areas in two hours.

• Hawaii is using COVID-19 relief funds to increase crisis stabilization program options in rural 

areas, with additional focus on specialty populations. 

• Idaho is using COVID-19 relief funds to increase use of telehealth solutions for crisis services 

when possible, especially to address needs in rural and remote areas of the state.

• Indiana is using COVID-19 relief funds to support a hotline for youth in rural communities to 

have better access to mental health supports through their primary care physicians.

• Kansas is using MHBG funds to develop and implement mobile crisis teams in four of Kansas’s 

most rural catchment areas.

• The Kentucky Rural Suicide Prevention Project is increasing awareness of resources, creating and 

disseminating farmer cultural humility trainings for behavioral health providers, including 

numbers able to recognize suicide risk by providing gatekeeper trainings and increased 

surveillance to identify high-risk geographic areas based on self-harm emergency department 

data.

• In Louisiana, mobile crisis teams are available to rural areas and are expected to respond within 

two hours. 

• Maryland is directing COVID-19 relief funds to mostly rural jurisdictions that lack a robust crisis 

response system and faces challenges due to geographic location and limited community 

behavioral health services. 

• Michigan noted in its MHBG application that rural areas are a special focus of developing crisis 

services. . The SMHA also noted that the adoption of mobile crisis to fidelity differs between 

rural and urban regions, with the more rural areas typically struggling with implementation 

because of demand unpredictability and large coverage areas. The SMHA is using funds to 

develop a mobile crisis model that will follow SAMHSA standards and will work in both rural 

and urban areas of the state.

• Minnesota is utilizing ARPA funds for the purchase of iPads and telemedicine 

platforms/technology to allow for telemedicine delivery of service in rural areas when appropriate 

to provide immediate response when needed. Funds are also being used to improve the 

information technology infrastructure, including the availability of broadband and cellular 

technology for providers, especially in rural and remote areas; the use of GPS to expedite 

response times; and to remotely meet with individuals in crisis.

• Missouri is using COVID-19 relief funds to enhance mobile outreach capability in rural areas. 

• Nevada offers local crisis call lines across the state, including in a rural region that contracts with 

a provider or after-hour crisis calls. There are four planned crisis stabilization units with the 

potential for rural partners. The state is also working with rural populations to expand Mental 

Health First Aid training in rural areas. The SMHA also acknowledged a lack of adequate access 

to mobile crisis teams in rural and remote areas of the state.

• New Hampshire is implementing mobile crisis and crisis stabilization services in rural areas.

• In New Mexico, mobile crisis teams and crisis receiving models are being developed, with a 

special focus on assisting and coordinating care for people in rural and frontier communities, and 

would be dispatched from the call centers.
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• New York’s SMHA indicated in its MHBG that mobile crisis services are not provided 

consistently 24/7/365 consistently across the state, but that counties and regions are moving 

toward that standard with a goal of 100 percent coverage including rural areas.

• North Carolina offers telepsychiatry services to divert emergency department utilization to 

accessible alternative community-based crisis stabilization and targeted communitybased treatment services and support transitions and sustain treatment services engagement in 

some of the state’s most rural and historically marginalized communities. Funding is being 

provided to more than 80 rural hospitals to divert and reduce the utilization of emergency 

departments in crises.

• Pennsylvania’s SMHA noted in its MHBG application that in order for the crisis system to 

succeed in the state, counties will need to form partnerships to provide the most comprehensive 

services while still reaching the majority of Pennsylvanians, whether they live in rural or urban 

areas.

• South Carolina’s MHBG supports the Highway to Hope Program, which consists of 14 

recreational vehicles that primarily serve as mobile office sites in rural areas of the state.

• South Dakota is looking to expand mobile crisis teams to rural, less-populated areas of the state 

with technological approaches through a Virtual Crisis Care Pilot program. The SMHA is 

expanding regional crisis stabilization centers to address mental health, and expanding crisis 

services in the central part of the state. Virtual CIT training for LEOs is also being implemented 

to support rural agencies that cannot take their officers offline for the traditional 40 hours of 

training.

• Tennessee is using ARPA funds to advance telehealth opportunities to expand crisis services for 

hard-to-reach locations, especially rural areas.

• Texas is using ARPA funds to work with local mental/behavioral health authorities to implement 

new crisis diversion programs in rural areas. 

• Utah is working on plans and projections for modified crisis stabilization centers in rural regions 

of the state, and plans to implement the changes in the third and fourth quarters of fiscal year 

2023. 

• Virginia is leveraging COVID-19 relief funds to create one position for crisis coordination. This 

position will facilitate the development of further crisis infrastructure and collaboration to ensure 

equitable implementation across both urban and rural areas. 

• West Virginia is establishing additional children’s mobile crisis response teams in more rural 

areas of the state, with the goal of decreasing response times to one hour. The expanded crisis 

response teams will continue the integration of mobile services into the crisis continuum in more 

rural areas of the state.

• Wyoming is leveraging public and federal funds to support 14 community mental health 

providers across the state. Four of these providers serve in strategic geographic areas as crisis 

centers providing acute psychiatric care and crisis stabilization. Access to care, especially crisis 

care, is often impeded by client proximity to services. 

Activities Identified to Improve Crisis Services for Individuals with CoOccurring Disorders 

• California’s SMHA serves individuals experiencing substance use crises and co-occurring mental 

health and substance use crises.
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• The District of Columbia makes crisis specialists and peer support specialists available to 

accompany individuals with mental health and substance use needs to follow-up appointments as 

needed.

• Florida has combined crisis stabilization units and addictions receiving facilities for adults and 

children that serve individuals with co-occurring mental health and substance use.

• Idaho is looking at integrated substance use solutions, which include follow-up for treatment of 

individuals who need solutions within the crisis response system. The SMHA is also looking to 

expand the development of crisis services to include specialized intervention services for 

individuals with co-occurring intellectual and developmental disabilities and behavioral health 

needs.

• Kansas offers crisis services for individuals with both mental health and substance use needs, 

including a help line for individuals with substance use needs and problem gambling needs. 

• Each community mental health center in Kentucky will have the capacity to respond to 

individuals in crisis with co-occurring disorders. These providers continue to increase crisis 

assessment and interventions for individuals with substance use and co-occurring disorders, 

including ASAM certification of crisis stabilization units, increasing capacity of staff in evidencebased practices, reconfiguring crisis stabilization units to serve individuals with substance use 

disorders or co-occurring disorders, and training on the administration of Narcan.

• Louisiana’s SMHA makes crisis services available to individuals with co-occurring conditions. 

• Maine’s crisis continuum provides linkages and referrals to substance use services for individuals 

engaged in the crisis system. As part of its commitment to serving the population experiencing 

co-occurring mental health and substance use disorder issues, the SMHA has established the 

Overdose Prevention Through Intensive Outreach Naloxone and Safety (OPTIONS) initiative. 

OPTIONS is a coordinated effort of the SMHA and other state agencies to improve the health of 

Mainers using substances through harm-reduction strategies, helping them on the road to 

recovery, and dramatically reducing the number of fatal and non-fatal drug overdoses. The 

OPTIONS co-responder initiative embeds licensed behavioral health clinicians (OPTIONS 

liaisons) within local emergency medical services and law enforcement agencies in each Maine 

county. OPTIONS liaisons respond to co-response/real-time response calls during the moment of 

crisis, and post-overdose follow-up visits in the days following a substance-use related crisis. 

Law enforcement partners often accompany OPTIONS liaisons during both co-response calls and 

post-overdose follow-up visits. OPTIONS liaisons act as a resource for alternative crisis 

intervention as well as contributing to prevention and follow-up efforts through community 

education and distribution of harm-reduction resources. 

• Mississippi makes crisis services available to individuals with substance use disorders.

• Nebraska’s SMHA contracts with the regional behavioral health authority networks to have a 

minimum capacity to provide emergency services 24-hours-per-day on an unscheduled basis to 

address acute psychiatric or substance use emergencies.

• New Hampshire provides mobile crisis teams and crisis stabilization units for individuals with cooccurring disorders, as well as the statewide crisis line for individuals experiencing mental health 

and substance use crises. The SMHA is using COVID-19 relief funds to make enhancements to 

the mental health crisis response system. Specialized mobile crisis teams will provide brief, 

episode-based interventions to individuals of any age who are experiencing both psychiatric 

and/or substance use-related crises.
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• New Jersey is using supplemental funding to develop additional crisis receiving and stabilization 

centers in each region of the state in an effort to divert emergency room admissions, inpatient 

admissions, and to provide services to individuals with SMI, SUD, or co-occurring disorders. 

• Mobile crisis teams in New Mexico respond to mental health and substance use emergencies.

• With the COVID-19 relief funds, New York is undertaking programmatic development and 

implementation of a new integrated mental health/substance use disorder crisis stabilization 

model, providing support for current crisis stabilization programs, and making connections to 

follow-up services for children and youth. 

• North Carolina has mobile crisis response in all 100 of its counties. COVID-19 relief funds will 

be used to support the enhancement of seven mobile crisis teams to address specific behavioral 

health and substance use needs of children and families in crisis.

• North Dakota’s eight Human Service Centers have all developed and implemented a crisis 

management program that provides help 24-hours-per-day, seven-days-per week to residents 

experiencing mental health, substance use, and emotional crises.

• Oklahoma is using COVID-19 relief funds to expand urgent recovery centers and crisis centers 

that provide stabilization services and a no-wrong-door approach to mental health and substance 

use crisis care.

• Oregon offers crisis care to individuals with other co-occurring disorders, including medical 

disorders and SUD. 

• Puerto Rico offers services to address emotional crises due to substance use.

• Rhode Island’s current crisis system is designed to provide a comprehensive range of mental 

health and substance use disorder services to vulnerable individuals. The goals of this project are 

to provide emergency crisis and evaluation services to reduce emergency department visits and 

admissions, intervene with crisis services to engage the client in a referral for treatment that will 

reduce the use of substances, expand access to emergency crisis services after normal business 

hours, and to provide referrals to treatment services for individuals who have or at risk for 

substance misuse and untreated behavioral health diagnoses. 

• Each mobile recreational vehicle team in South Carolina provides the opportunity for other 

caregivers, such as substance misuse counselors and/or primary medical care to accompany 

mental health staff. The state is also supporting crisis services by making mobile crisis response 

and crisis stabilization units better able to assess and assist in the appropriate disposition of 

individuals in crisis with co-occurring disorders. 

• A community mental health center in South Dakota is operating Safe Bed for individuals with 

both mental health and substance use disorder short-term crisis needs.

• The Crisis Hotline in Texas is a 24/7 telephone service operated by trained crisis staff providing 

crisis screening and assessment, crisis intervention services, mental health and substance use 

referrals, and makes general mental health and substance use information available to the 

community. 

• The Virgin Islands indicated in its MHBG that it recognizes a significant need to increase its 

capacity to provide treatment services to individuals with SMI, SUD, and co-occurring disorders, 

especially during the COVID-19 pandemic. Responders will receive a minimum of 40 hours of 

specialized training in psychiatric diagnoses, suicide intervention, substance use issues, 

behavioral health de-escalation, the role of family in behavioral health challenges or mental 

disorders, behavioral health and substance use laws, and local resources and procedures for 

individuals in crisis.
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 49

• In West Virginia, currently the main way to access intensive adult crisis services in the state is via 

regional crisis stabilization units which serve both the SUD and mental health populations. 

• In Wisconsin, mobile crisis teams will increase reimbursement options, provide improved safety 

for crisis workers, allow telehealth options, and require harm reduction and substance use 

treatment training for crisis staff.

Activities to Improve Crisis Services for Veterans and the Military 

• Connecticut offers Veteran Suicide Prevention services.

• Through the Delaware Suicide Prevention Coalition, the SMHA collaborates with the Division of 

Public Health, the Department of Services for Children, Youth, and their Families, the Delaware 

State Police, and the state’s Veterans Affairs and military divisions to identify shared needs and 

opportunities to address the mental health needs experienced by adults and children in Delaware. 

• In Illinois, SMHA staff are in the process of creating a suicide prevention campaign that includes 

a special focus on veterans, consistent with the Governor’s Challenge work, as well as a broader 

campaign to ensure those at risk are aware of resources.

• In Kansas, the SMHA and the Governor’s Behavioral Health Services Planning Council have 

provided grant funding to veteran’s programs and Crisis Intervention Training programs. 

• In Kentucky, crisis response staff are being trained to provide culturally responsive services to 

those identified as high risk, including military-connected families.

• Louisiana’s SMHA has entered into a contract with the Louisiana Center for Prevention 

Resources to provide a training series for service members, veterans, and their families to raise 

awareness of SMI and SED among the population in an effort to link them to available services 

and resources.

• Maryland’s SMHA identified a current need for safety training that teaches service members, 

veterans, and their families proper techniques and tools to reduce the potential for a weaponrelated accident. The training also provides a focus on suicide prevention for this population who 

have easy access to weapons. As this training effort targets service members, veterans, and their 

families who have a national suicide rate 1.5 times that of a non-veteran adult, it is expected that 

individuals being served through this effort will have an SMI/SED or be the family member of an 

individual with an SMI/SED. In the state’s ARPA plan, the SMHA elaborated that the 

Intervention, Treatment, and Recovery Support Services project’s goal is to expand a primary 

care provider safety planning training program. The project will host a learning pathway for 

health care providers, provide safety-planning kits and designation for providers completing the 

learning pathway, and work in conjunction with jurisdictions conducting crisis intercept mapping 

(including urban, suburban, and rural). This project is important because not all veterans who 

experience suicidal ideation or behavior have mental health diagnoses or engage in mental health 

services. Focusing on primary care staff broadens the scope of suicide prevention, allowing reach 

to a greater proportion of service members, veterans, and their families not served by the 

Veterans Affairs Administration.

• Michigan’s SMHA involved veterans in the development of their crisis line. The SMHA also has 

a Veteran Liaison and routinely collaborates with the Michigan Veteran Affairs Agency.

• Nebraska has a Veterans’ Crisis Line.

• Ohio sponsors Veteran Gatekeeper Suicide Prevention.

• Oregon’s SMHA proposed in its ARPA plans that a veteran/military behavioral health conference 

would be beneficial to highlight work from the Oregon Health Authority’s suicide prevention 

team.
Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

State Program Improvement TA Project 50

References

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2 U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services 

Administration (SAMHSA). (n.d.). FY22-23. Block grant reporting section. CFDA 93.958 (mental health). 

https://www.samhsa.gov/sites/default/files/grants/fy22-23-mhbg-report.pdf 3 Calculated as 5 percent of the sum of all state community mental health services block grant awards. 

HHS, SAMHSA. (2022). SAMHSA grant awards by state, fiscal year 2022.

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Snapshot of Behavioral Health Crisis Services and 

Related Technical Assistance Needs Across the U.S. 

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36 Ezekiel et al. (2021, August), p. 11. 

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