The number of people experiencing mental health crises is up—drug overdoses and suicides have overtaken traffic accidents as the two leading causes of death among young Americans ages 25-44. Unfortunately, individuals in crisis often do not receive appropriate and effective response and do not get the care and help they need.

Law enforcement officials are often the first to respond to a mental health crisis and they are often untrained and unprepared to respond to the individuals’ needs. People in crisis often end up in overcrowded emergency rooms or in jail cells instead of receiving needed mental health and related services.

A major step forward in improving the crisis response will occur next July as a result of the recently passed National Suicide Hotline Designation Act. Beginning in July 2022, there will be a new nationwide crisis response number—988—similar to the nationwide emergency 911. Once in place, a call to 988 will connect to the National Suicide Prevention Lifeline, which consists of a network of more than 180 local- and state-funded crisis centers across the U.S. These centers already respond to millions of calls and chats from people in distress each year. Robert Gebbia, CEO of the American Foundation for Suicide Prevention (AFSP), noted in recent congressional testimony that the implementation of the 988 “offers a unique opportunity to rethink and reimagine mental health crisis response.” Also testifying at the hearing, Charles Dike, M.B.Ch.B., M.P.H., an associate professor of psychiatry at Yale University School of Medicine, medical director of the Connecticut Department of Mental Health and Addiction Services, and chair of APA’s Ethics Committee, emphasized that communities must have the infrastructure required to respond to these calls: “Success in the future depends on strengthening and funding the mental health infrastructure.”

Crisis response is much more than just one hotline or one program. A recent report from the National Council for Mental Wellbeing* defines a behavioral health crisis system as “an organized set of structures, processes and services that are in place to meet all the urgent and emergent behavioral health crisis needs of a defined population in a community, as soon as possible and for as long as necessary. In short, a crisis system involves an array or continuum of components, processes and services managed collaboratively and interlinked.” The images below depict the current crisis system and a model interconnected crisis system (from NASMHPD, Crisis Services: Meeting Needs, Saving Lives. 2020).

These systems must be able to respond to the full range of crisis experiences and the full range of individual diversities and needs. They have to be prepared for people of all ages, people with varying medical conditions and physical or cognitive disabilities, and cultural and language issues, and to include family members or those who care for them. A crisis system should potentially include a call center, first responders, mobile crisis units, crisis beds, acute inpatient beds, and other mechanisms for ongoing crisis intervention. The charts below graphically depict the current crisis system and the components of an integrated model crisis response system.

Many states and communities have undertaken initiatives to better address mental health crises. Some have established Crisis Intervention Teams which are made up of law enforcement officials who have received specialized training in de-escalation and linking individuals to mental health care crisis services. Mobile Crisis Teams used in some communities involve behavioral health professionals intervening at the scene of a crisis to provide mental health and substance use assessments or to connect people to services, and to work with law enforcement when needed. Co-Response Teams, another approach, are coordinated teams of mental health professionals and law enforcement officials who respond together to provide on scene support, assessment and referrals rather than arrest.

Another element to the crisis system is individual planning and preparation. The My Mental Health Crisis Plan app is designed to help with that process. It was developed by SMI Adviser, an initiative administered by the American Psychiatric Association and funded by the Substance Abuse and Mental Health Services Administration. The My Mental Health Crisis app allows individuals who have serious mental illness to create a plan to guide their treatment during a crisis. It provides a step-by-step process to create and share a psychiatric advance directive, including stating preferences for treatments, designating a trusted person as a decision-maker on their behalf, and identifying who should be notified in the event they experience a mental health crisis. who should be notified in the event they experience a mental health crisis.

Webinar on Crisis System Transformation

On July 13, APA is hosting, in conjunction with National Association of State Mental Health Program Directors, National Council for Mental Wellbeing, and American Foundation for Suicide Prevention, a free webinar to address these issues. Webinar attendees will hear from a panel of experts:

• Stephanie Le Melle, M.D., Director of Public Psychiatry Education at Columbia University.
• Robert Gebbia, CEO of American Foundation for Suicide Prevention.
• Debra Pinals, M.D., Medical Director of Behavioral Health and Forensic Programs for the Michigan Department of Health and Human Services, and Chair, APA Council on Psychiatry and the Law
• Keris Myrick, M.B.A., M.S., Co-Director of Mental Health Strategic Impact Initiative (S2i).