Federal Focus on Behavioral Health Crisis Care 

You may be thinking that we’ve been writing a lot about behavioral health on Say Ahhh! lately. Well, you’re right – and there’s more!

For starters, last week, the Substance Abuse and Mental Health Services Administration (SAMHSA) released new National Guidelines for Child and Youth Behavioral Health Crisis Care, complementing other recent resources such as their recent compendium of technical assistance, From Crisis to Care. The Guidelines outline best practices and practical guidance for behavioral health care services for youth. The three core services discussed may sound familiar:

Someone to Talk To – Regional Crisis Call Center

With this summer’s launch of the 988 crisis lifeline, there has been renewed attention in the role of crisis call centers that serve as an entry point into the behavioral health crisis system, rather than law enforcement or hospital emergency departments. Available via call, text, and chat, crisis call centers provide developmentally appropriate screenings and brief interventions, and should employ staff with specialized training to meet the needs of youth. The Guidelines provide best practices for call center technological capabilities and essential operations as well as staffing and training.

Someone to Respond – Mobile Crisis Team Response

Mobile crisis teams respond to crises in the community, typically in teams of two from an interdisciplinary team of social workers, nurses, peer support providers, and more. Their services include de-escalation, assessment, safety planning, identification of next steps, referrals to additional care as needed, transitions to crisis stabilizations or hospitals as needed, and follow-up. The Guidelines provide best practices for staffing and training, de-escalation strategies, safety planning, and care coordination.

A Safe Place to Be Crisis Receiving and Stabilization Services

Crisis receiving and stabilization services are essential for youth needing additional support, but whose needs do not rise to the level of hospitalization. The goal of crisis facilities should be to help youth return home with any needed outpatient supports. In the Guidelines, SAMHSA prioritizes home-based stabilization supports for youth, such as peer support, parent education, behavior management training, and conflict management skill building, for which family involvement is strongly encouraged

In addition to core principles like trauma-informed care for the broader crisis continuum, SAMHSA also outlined important values for the youth crisis continuum. These include keeping youth in their homes and communities, having developmentally appropriate services and diagnostic criteria (including adoption of the DC:0-5 Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood to ensure that early childhood crisis services are reimbursable), integrating people with lived experience into service planning, implementation, and evaluation, and having services that promote equity in behavioral health. 

In addition to SAMHSA’s release of the Guidelines, the U.S. Senate Finance Committee also formally released its fourth discussion draft as part of its ongoing bipartisan committee working group process focused on mental health. The mental health integration draft includes various components with a particular focus on crisis care including proposals to direct the Administration to issue guidance outlining best practices and recommendations for building the crisis continuum under Medicaid and CHIP, establish a technical assistance center to assist state Medicaid programs in designing and implementing a continuum of crisis response services, provide planning grants to states to assess and address crisis needs, and making the American Rescue Plan Act community-based mobile crisis intervention services state option permanent. The discussion draft also includes Medicare provisions focused on crisis care including proposals to require the Centers for Medicare & Medicaid Services to establish certain payment methodologies for mobile crisis response team services and crisis stabilization services for Medicare beneficiaries. 

Mental health crisis services are essential for supporting youth and their families when they need it most. However, crisis services must be part of a larger continuum of services that support youth before, during, and after a crisis occurs. Historic attention and investments are helping to support improvements to this long underfunded and overstrained system, however, much work remains. As SAMHSA Secretary Dr. Miriam Delphin-Rittmon wrote in her opening remarks for the new Guidelines, “it is not the final word—it is a beginning.” 

***The national 988 system is live in the U.S. for calls, texts, and chat for use when you or someone you know is experiencing a mental health crisis. Calls to the previous 11-digit number for the National Suicide Prevention Lifeline [1-800-273-8255 (TALK)] will be routed in the same manner as calls to 988.