Most mental health crisis services did not increase following 988 crisis hotline launch

The launch of the nation’s 988 mental health hotline did not coincide with significant and equitable growth in the availability of most crisis services, except for a small increase in peer support services, according to a new RAND study.

Examining reports from thousands of mental health treatment facilities about the types of crisis services offered before and after the July 2022 rollout of the 988 hotline, researchers found that there was an increase in peer support services, a significant decrease in psychiatric walk-in services, and small declines in mobile crisis response and suicide prevention services.

Significant variation across states was observed in service availability trends before and after 988. The findings are published in the journal JAMA Psychiatry.

“The lack of meaningful growth in most crisis services may limit the long-run success of 988, in particular if callers feel that reaching out to 988 fails to result in access to appropriate sources of care,” said Jonathan Cantor, lead author of the study and a policy researcher at RAND, a nonprofit research organization. 

“Mental health officials and policymakers should consider strategies to boost the financing and availability of crisis services at mental health treatment facilities to meet increased demand generated by the 988 Suicide and Crisis Lifeline,” Cantor said. 

The 988 Suicide and Crisis Lifeline provides an easy-to-remember phone number to access trained crisis counselors and emergency mental health services. It replaced the National Suicide Prevention Lifeline, which had been reachable via an 800 phone number and was narrowly focused on suicide as opposed to mental health crises more broadly. 

The 988 crisis line is intended to complement other forms of mental health emergency response services and connect callers with a variety of mental health services on the crisis care continuum.

However, mental health emergency response systems may not be amenable to rapid change despite increases in demand prompted by 988. In particular, the U.S. continues to contend with a shortage of psychiatric beds in many regions, as well as a limited and unevenly distributed mental health care workforce.

RAND researchers evaluated the availability of crisis services offered by mental health treatment facilities throughout the U.S. from November 2021 through June 2023.

Information came from details reported by licensed mental health treatment facilities to the Substance Abuse and Mental Health Services Administration. RAND has aggregated that data over time to create the longitudinal Mental health and Addiction Treatment Tracking Repository. The study included information from a large sample of reports from more than 15,000 mental health treatment facilities nationally.

The largest changes were observed for peer support services, which increased from being available at 39% of facilities prior to 988 to 42% afterward, and for availability of emergency psychiatric walk-in services, which declined from 32% to 29%.

The availability of other service types at mental health treatment facilities also declined at the national level. Mobile crisis response dropped from being provided by 22% of facilities before the rollout of 988 to being offered by 21% afterward. The availability of suicide prevention services dropped from 69% to 68% over the period.

There were also significant differences observed in crisis service availability based on facility characteristics. For example, public facilities had the highest odds of offering each of the four crisis services, followed by not-for-profit facilities. For-profit facilities, which comprised about one-quarter of the sample, consistently had the most-limited services.

State-level rates of suicide prevention services remained the same for most states over the study period. The largest increase in the availability of suicide prevention services was seen in Montana (11.5% increase), and the largest decline in availability was in Rhode Island (11.4% decrease). 

In contrast, most states experienced an increase in the number of facilities offering peer support services. The largest gain in offering of peer support services was in Kansas (19.6% increase) and the largest decline in peer support services was found in Georgia (3.2% decrease).  

Support for the study came from the National Institute of Mental Health. Other authors of the study are Megan S. Schuler, Rose Kerber and Ryan K. McBain, all of RAND, and Jonathan Purtle of New York University. 

RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.