Building the Evidence Base for the National Crisis Care Continuum

Body of Abstract: Research Aims
In response to the national epidemic of loneliness, isolation, opioid overdose, and mental health challenges facing our country, the nation is undergoing a behavioral health care transformation with incredible investments from the Federal government. In 2020, recognizing the need to expand and improve the national mental health crisis response, Congress designated a three-digit dialing code (988) to route clients to an expanded suicide and crisis lifeline. SAMHSA leads this effort in partnership with the Federal Communications Commission (FCC) and the Department of Veteran Affairs (VA).
In the spring of 2022, President Biden proposed a comprehensive national strategy to address the mental health crisis, calling for a major transformation in how mental health is understood, accessed, treated, and integrated both within and outside healthcare settings. The plan includes initiatives to strengthen crisis care and suicide prevention infrastructure by expanding access to mobile crisis services in high-need communities and investing in behavioral health services for prevention, screening, treatment, and other support. (White House, 2022).
To support the transformation of behavioral health care services, the Biden-Harris Administration has invested nearly $1.5 billion to implement the 988 Suicide & Crisis Lifeline and BHCSC. This investment underscores the Administration’s deep passion and commitment to building and evolving an end-to-end services continuum to ensure that anyone in crisis receives the necessary help and support.
Consistent with the 2024 National Strategy for Suicide Prevention and SAMHSA’s Strategic Plan, SAMHSA has committed to understanding the implementation journey and outcomes for crisis service systems, care providers and individuals in need. The 988 Suicide & Crisis Lifeline and Crisis Services Program Evaluation is reflective of that commitment, with the evidence generated from the evaluation playing a significant role in informing policy and funding decisions, thereby improving the overall effectiveness of the U.S. behavioral health crisis response.
The evaluation is designed to assess the implementation and expansion of the 988 Suicide & Crisis Lifeline and behavioral health crisis care continuum (BHCSC) within states and across the United States (U.S.). The multi-method, multi-study evaluation combines primary and existing data to answer the most compelling questions in the field, including: How are partnerships being built? What are the parts and pieces of the end-to-end response systems? Are ALL individuals in crisis being effectively linked to care and what are the short- and long-term benefits of that linkage? Are crisis services that individuals receive effective in reducing suicidal ideation and overdose risk? Has the 988 Suicide & Crisis Lifeline and BHCSC had an impact on national suicide and overdose statistics?
Methods
The 988 Lifeline and Crisis Services Program Evaluation includes three levels: system-level, client-level, and impact. Embedded within each of the three evaluation levels are inquiries into behavioral health equity to investigate disparities in utilization of 988 Lifeline and BHCSC services and outcomes.
The System-level Evaluation examines the characteristics, collaborations, and structures of the crisis services infrastructure within states, territories, and Tribal jurisdictions that support improved client outcomes. The Systems-level Evaluation also explores whether the 988 Lifeline and BHCSC are successful in creating a behavioral-health-system-first response to crisis events and the resulting reduction in use of non-behavioral health crisis services (e.g., 911, law enforcement, emergency medical services).
The Client-level Evaluation will provide critical information about the ways in which the 988 Lifeline and crisis services fulfill their mission to connect those in crisis with the services and supports needed to reduce crisis risk and improve overall behavioral health outcomes.
The Impact Evaluation will inform SAMHSA’s efforts to continue to build the evidence base for suicide prevention and crisis programming. Specifically, this evaluation will examine the impact of 988 Lifeline and BHCSC on suicide and overdose morbidity and mortality. The Impact Evaluation employs a quasi-experimental interrupted time series (ITS) design using extant, secondary data sources to establish longitudinal state-level trends before and after major milestones in the implementation of the 988 Lifeline and BHCSC.
Results/

Conclusions:
This presentation is an opportunity to inform the field about the evaluation approach – a critical milestone in building the evidence base for crisis service response in the U.S. - as we await required regulatory approvals (anticipated April 2025). In line with the “in the works” submission category, we will invite audience reactions to the approach, solicit suggestions for best practices in engaging individuals in crisis in research, and gather any additional feedback regarding our planned training and technical assistance activities.

Learning Objectives:

• Describe the 988 Suicide & Crisis Lifeline and Crisis Services Program Evaluation.
• Prepare for their role in supporting the collection of data for the 988 Suicide & Crisis Lifeline and Crisis Services Program Evaluation.
• Explain the value of developing the evidence-base for the 988 Suicide & Crisis Lifeline and Behavioral Health Crisis Services Care Continuum.