Access to Timely, High-Quality Behavioral Health Crisis Care

To: State, territorial, tribal, and local policymakers and administrators of systems, agencies, and programs responsible for children, youth, and family health and well-being

Dear Colleagues,

Thank you for the work you do each day to support children, youth, and families across the country. The Administration for Children and Families (ACF) would like to highlight the critical importance of timely, high-quality behavioral health crisis care and make sure you are aware of how these resources can be accessed in your communities.

Too many people are experiencing suicidal crisis or mental health-related distress without the support and care they need, and this is particularly true for children, youth, and families. Trends in suicide attempts and deaths by suicide have been increasing among adolescents and remain a major public health concern. In 2023, 3.2 million adolescents aged 12 to 17 (12.3 percent) had serious thoughts of suicide in the past year, 1.5 million (5.6 percent) made suicide plans, and 856,000 (3.3 percent) attempted suicide. Vulnerable adolescent populations exposed to adverse childhood experiences are at particular risk of suicide and related behaviors.

Someone to contact: The 988 Suicide & Crisis Lifeline

988 offers one-on-one, skilled, compassionate mental health and substance use support for anyone at any time. 988 counselors are trained to understand how an issue is affecting a person and share resources that may be helpful. People can call or text 988 or chat 988lifeline.org 24/7 for themselves or if they are worried about a loved one.

The 988 dialing code is made up of a national network of more than 200 local crisis contact centers that are equipped to handle thousands of contacts each day. When someone calls 988, they first hear a greeting message. They are then given choices of who to connect with. The 988 Lifeline has specially trained counselors for veterans, Spanish speakers, LGBTQI+ youth and young adults, and Deaf and Hard of Hearing people. The 988 Lifeline uses Language Line Solutions to provide translations to callers in more than 240 additional languages, and is also working to ensure broad accessibility to make sure that all people can receive needed support, including those with intellectual and/or developmental disabilities, those with brain injury, and those with other disabilities. Since Congress designated 988 in 2020 and the three-digit number went live in 2022, there has been a significant investment of federal resources to scale up crisis centers across the country. 988 is an important step forward and offers an unprecedented opportunity to strengthen and transform behavioral health crisis care in our country.

There are a number of other federally funded hotlines that offer critical support and intersect with topics related to emotional distress and crisis. Use your best judgment as to the most appropriate resource for the situation when directing the public to different hotline resources. For your convenience, a list of ACF- and select federally supported hotlines is included at the bottom of this letter (see Tables A, B). When suicide presents as a risk, please refer to 988. 911 should only be used for situations posing immediate physical danger, such as suicide attempts in progress, medical emergencies, or immediate threats to safety.

Someone to respond and a safe place to go: The importance of trained face-to-face response

The vast majority of those seeking help from the 988 Lifeline do not require any additional emergency interventions at that moment. However, there are instances when an in-person response is needed. The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines two core components that every community should work to have in place when these instances arise: mobile crisis teams that can reach individuals where they are in the community, and crisis stabilization facilities that can provide observation and stabilization services in a non-hospital environment. Currently, availability and utilization of these services varies across the country. The availability and number of these services has been expanding over the last several years, and SAMHSA’s long-term vision is for full access to mobile crisis services and crisis stabilization facilities across all communities. Your local public health agency or state behavioral health agency will be able to answer questions you might have about what face-to-face behavioral health crisis services are in place in your community.

Role of ACF grant recipients and partners

While this is an important time to reimagine how we provide crisis services in the United States, the full vision of a transformed crisis care system with 988 at its core depends heavily on the engagement of leaders in the systems, agencies, and programs responsible for children, youth, and family health and well-being. Your involvement is essential to ensuring children, youth, and families are aware of 988 and other crisis response options in their communities. You are also critical partners in ensuring that the voices and needs of children, youth, and families are represented in decisions around the types of crisis services offered in your communities.

Suggested Actions

Here are some actions that grant recipients and partners can take:

• Spread the word about 988 as a place to turn for free and confidential support for any type of behavioral health distress. Check out the SAMHSA 988 Partner Toolkit for answers to frequently asked questions and for access to digital promotion materials. You can also order print materials at no cost from the SAMHSA 988 Print Materials Web Page .
• Identify the best point of contact within your local public health agency or state behavioral health agency to answer questions you might have about what face-to-face behavioral health crisis services are already in place. A list of 988 Lifeline crisis centers by U.S. state and territory can also be found on the 988 Lifeline Web Page .
• Find out if there are active conversations happening in your state and/or community regarding behavioral health crisis services. Ask how agencies and organizations working with children, youth, and families are being engaged and seek opportunities for your organization and the populations you serve to be involved.

Thank you for your dedication and partnership. If you have any questions, please contact your local public health department or state behavioral health agency. Together, we can ensure that all children, youth, and families have someone to contact, someone to respond, and a safe place to go in moments of crisis.

/s/

Meg Sullivan
Principal Deputy Assistant Secretary

Table A: ACF-Supported Hotlines

Table B: Select HHS-Supported Hotlines (Not Comprehensive)