For nearly two centuries, the United States has struggled to build humane and effective responses to mental health crises. Today, the consequences of fragmented systems remain clear: individuals experiencing mental illness or suicidality are too often routed through emergency rooms, homelessness, or the criminal justice system when community-based care would better meet their needs.

Efforts to reform behavioral health crisis response date back to the mid-19th century. In 1843, social reformer Dorothea Dix began advocating for the creation of psychiatric hospitals to remove individuals with mental illness from county jails and provide more humane treatment. Her work helped drive the development of large state psychiatric hospitals, which by the mid-20th century housed hundreds of thousands of individuals.

By the 1960s, concerns about institutional conditions led to a new push toward community-based care. President John F. Kennedy’s Community Mental Health Act of 1963 envisioned a national network of community mental health centers designed to replace institutional care with locally accessible services; however, the broader system of community-based services was never fully funded. As large institutions closed without sufficient community infrastructure to replace them, many individuals with serious mental illness once again became entangled in the criminal justice system.

Law enforcement leaders and county governments have worked to address the growing role of jails as de facto mental health facilities. Initiatives such as the Stepping Up campaign and the One Mind Campaign have encouraged communities and law enforcement agencies to adopt policies and training designed to improve responses to people experiencing behavioral health crises. These efforts have highlighted a critical truth: public safety systems cannot solve this challenge without a robust behavioral health crisis response system.

Recent federal legislation has significantly improved the nation’s behavioral health crisis response infrastructure. The National Suicide Hotline Improvement Act of 2018 and the National Suicide Hotline Designation Act of 2020 established 988 as the national number for suicide and behavioral health crises. While these actions created a critical access point for people in crisis, states must now ensure that comprehensive crisis response systems are in place to support those who seek help.

In 2025, the Substance Abuse and Mental Health Services Administration (SAMHSA) published the National Guidelines for a Behavioral Health Coordinated System of Crisis Care, which outline three essential components of an effective crisis response system:

• Someone to Contact: 988 Lifeline and Other Behavioral Health Lines
• Someone to Respond: Mobile Crisis and Outreach Services
• A Safe Place for Help: Emergency and Crisis Stabilization Services

Together, these elements form the foundation of a modern behavioral health crisis response system—one that saves lives, reduces strain on emergency services, prevents the criminalization of health conditions, and connects individuals to meaningful treatment and recovery supports.

Governors and state legislators play a critical role in ensuring that behavioral health crises are met with care rather than criminalization. While some states, including Virginia, Tennessee, and Washington, have made significant investments in coordinated crisis systems, many others have yet to align their policies and funding with SAMHSA’s 2025 National Guidelines.

Recommended Policy Actions:

The Crisis Collaborative, a body representing crisis call takers, mobile crisis teams, co-responders, Crisis Intervention Team (CIT)–trained law enforcement officers, police social workers, crisis residential providers, and crisis system researchers, urges state leaders to implement these national guidelines and take the following policy actions:

1. Pass legislation establishing a regulatory framework for crisis services and ensuring adequate reimbursement structures within the state Medicaid plan and through general fund appropriations to support crisis call centers, mobile crisis teams, emergency behavioral health walk-in centers, crisis respite programs, and crisis residential services.
   
   
2. Ensure private insurers reimburse for all regulated and licensed crisis services without requiring pre-authorization, with particular attention to reimbursement for emergency behavioral health walk-in centers, crisis respite programs, and crisis residential services.
   
   
3. Amend the Emergency Medical Treatment and Labor Act (EMTALA) that governs ambulance transport and explicitly permits reimbursement for transport to emergency behavioral health walk-in centers so that law enforcement is not required to transport individuals to treatment.
   
   
4. Ensure that at least 90% of federal 988 funding allocated to state mental health authorities is designated to support operations of 988 call centers.
   
   
5. Establish in-person state training mandates and standards for law enforcement officers focused on de-escalation and understanding mental illness and suicidality.
   
   
6. Elevate the role of certified peer specialists and peer-run services as critical to a full continuum of crisis response through state law and policy.
   
   
7. Provide adequate funding and insurance reimbursement for alternatives to incarceration, including Assertive Community Treatment (ACT), which provides intensive community-based support for individuals with acute mental illness without requiring institutionalization.
   
   
8. Require clinical engagement to explore treatment options prior to execution of an involuntary commitment, recognizing that far fewer individuals benefit from forced treatment than are currently subjected to statutory mandates.
   
   
9. Support various models of mobile response, allowing communities to provide the service in a manner that best serves the members of their community.
   
   
10. Fund Housing First models to address and elevate the chronic challenges of homelessness.

Each one of the desired outcomes articulated above will require significant multidisciplinary advocacy efforts. Implementing a coordinated behavioral health crisis response system requires decisive leadership at the state level.

With thoughtful legislation, strategic funding, and collaboration across behavioral health and public safety sectors, states can build crisis response systems that save lives, support recovery, and reduce the criminalization and stigmatization of mental illness.

Who Are We

The Crisis Collaborative is a partnership between the American Association of Suicidology, Crisis Intervention Teams International, the International Co-Responder Alliance, and People USA.

Our Goal

Recognizing that every community is unique, our mission is to advance state-specific legislative and regulatory changes that include the funds necessary for communities to deliver timely, compassionate, and impactful crisis responses.

Our Shared Values: Every person experiencing a suicidal or mental health crisis deserves a rapid response that is empathetic and access to quality care that best meets their individualized needs.

Our Approach

The Crisis Collaborative comprises multiple entities whose members include peer specialists, law enforcement officers, fire/EMS professionals, corrections professionals, mental health clinicians, police social workers, mobile crisis responders, crisis call takers, and suicidologists. We strongly support SAMHSA’s Vision of “Someone to Call, Someone to Respond, and Somewhere to Go.” However, we do not believe service or responses should be narrowly defined. It is critical that options are elevated and supported in state policy. Options like peer-run respite centers and alternative mobile responders working in partnership with a CIT Officer on a co-responder team.

We recognize that an impactful and compassionate crisis response will look different in Wyoming or Maine than in Philadelphia or Chicago. Fundamentally, we do not believe that any one organization speaks for the crisis continuum, just as there is not one approach to prevent suicide or the criminalization of mental illness.

Together, we work to advance crisis system transformation that respects the resources, cultures, and diverse identities of people living in each state, territory, and First Nation.

Crisis Collaborative Representatives:

Contact Information:

Anthony Merklinger
Community Engagement Manager
American Association of Suicidology
anthony@suicidology.org