Legislative Responses
Someone to Talk To
State legislation has helped to expand call center capacity. Call centers can provide immediate support for people in crisis, connecting them to care or providing crisis stabilization services. A 2018 evaluation found that nearly 80% of callers interviewed six to 12 weeks after calling said their calls kept them from attempting suicide, provided them with hope and helped them connect with mental health resources. Local call centers can do this more efficiently than distant ones by connecting people to community resources.
Delaware enacted legislation in 2024 that imposes a 60 cents per month surcharge on telecommunications services to support the Crisis Intervention Services Fund. Authorized uses include establishing, operating maintaining or improving 988 or crisis intervention services, including personnel costs, technology, and infrastructure enhancements.
Funds can also be used for recruiting and retaining qualified personnel, providing specialized training, raising public awareness of 988, behavioral health crisis intervention services and education on behavioral health conditions, data collection and analysis, and other services related to crisis response teams. The legislation creates the Behavioral Health Crisis Services Board to provide oversight and input on the development of an integrated behavioral health crisis system in the state.
Indiana took an additional step, directing their state Medicaid agency to apply for a waiver from the Centers for Medicare and Medicaid Services to allow for reimbursement of 988 services for people enrolled in Medicaid. Effective July 1, 2023, the Indiana Medicaid program began providing coverage for crisis intervention services rendered by mobile crisis teams designated by the state’s Department of Mental Health and Addiction.
Guidance released by the Centers for Medicare and Medicaid Services (CMS) in 2018 allows for some flexibility in using an administrative match for crisis call centers. CMS also allows for some Medicaid administrative dollars for “state Medicaid agency costs associated with establishing and supporting delivery of community-based mobile crisis intervention services” as part of new options available in state plans. Georgia, for example, claims Medicaid administrative funds to help support their Georgia Crisis and Access Line (GCAL), where calls to 988 are also routed.
Maryland enacted legislation in 2024 to permanently fund the 988 helpline through a 25 cents monthly cell phone fee. Earlier legislation created a 988 trust fund when the 988 line was initially launched. Since that time, calls to the hotline in the state have increased 50% and text messages have increased 1,000%.
In 2020, Utah unanimously approved legislation supporting the existing statewide mental health crisis line and created a statewide warmline, which can be staffed by peer counselors. The crisis line is required to be staffed by mental health therapists or crisis workers and be accessible 24 hours a day, 365 days a year. The legislation appropriated more than $16.7 million for the new warmline and related initiatives in the first year.
Despite recent legislative efforts to support the 988 line, a recent survey showed that most adults still remain unaware of the resource. An estimated 13% of adults knew about 988 about nine months after it was launched.
At least one state has started to address the issue of awareness. Washington’s most recent legislation addressing 988 requires every licensed or certified behavioral health agency to display the number in common areas, include it as an option in any phone messages and on discharge summaries. The state also created a 70 cent fee to support responses to the 988 lifeline.
Someone to Respond
States have taken steps to establish and expand crisis response options to ensure greater access to services, including in rural areas.
One of the first legislative responses was to provide law enforcement officers, who are sometimes the only option for a mobile response, with additional training on crisis intervention.
The majority of states now require crisis intervention team (CIT) training, provide funding for CIT training or have established training standards. States have also gone beyond CIT training by requiring additional or other specialized training, such as recognizing symptoms of mental illness and substance use disorders, de-escalation and familiarity with conditions such as dementia, Alzheimer’s or autism.
States have also addressed co-responder units that partner behavioral health professionals with law enforcement. Legislation in Colorado created a statewide grant program, managed by the Division of Criminal Justice, to provide funding to law enforcement agencies, local governments, community-based agencies and other qualified groups to support co-response and other community-led crisis response programs.
Other states have expanded community-based responses that don’t include law enforcement. Utah unanimously enacted legislation in 2020 that increased the number of mobile crisis outreach teams which are mobile teams of medical and mental health professionals that, in coordination with law enforcement and emergency medical service personnel, provide mental health crisis services.
The legislation specifically targeted rural areas by appropriating $2.4 million for grants to rural jurisdictions that are establishing new teams. Funding was also allocated for purchase, maintenance and replacement of vehicles. Subsequent legislation in 2021established the Mental Health Crisis Intervention Council to develop statewide protocols and standards for local mental health crisis interventions teams and implementation and oversight of state and local crisis intervention teams.
According to a recent report from the Crime and Justice Institute, at least 10 states have appropriated funds to state agencies to support mobile crisis teams. Some of the laws identified required prioritizing funding for rural areas.
A Place to Go
For individuals that need a greater level of care than can be provided by mobile teams and first responders, states have expanded access to care at crisis stabilization centers and other receiving facilities, including Certified Community Behavioral Health Clinics (CCBHC). These facilities can serve as an alternative to emergency departments, which tend to be more expensive and are not always best equipped to provide appropriate treatment. As of 2022, about 430 CCBHCs operate in over 40 states, Washington, D.C., and Guam.
CCBHCs can provide services outside the physical location of a clinic around the clock. The model also allows for coordination with criminal justice stakeholders, including law enforcement and court officials. Some states report that coordinating services across CCBHCs has saved money while helping patients achieve better outcomes. In jurisdictions using this coordinated model there have been reductions in hospitalizations, incarceration and homelessness for program participants.
Missouri reported a 66% decrease in requests for crisis intervention services, while 85% of those referred for inpatient hospitalization were diverted to community care options. In Oregon, a CCBHC partnership with a local jail estimated a savings of $2.5 million.
Arkansas was one of the first states to set up a statewide system of crisis stabilization centers. In 2017, the state enacted legislation, which authorized and established the framework for operating regional crisis stabilization units across the state.
The units are clinical facilities that provide short-term stays for people in need of assessment and treatment services for behavioral health conditions. Law enforcement officers can refer individuals arrested for nonviolent offenses to a unit. The facilities can also receive people referred by community mental health centers.
New York enacted legislation in 2021 that designated crisis stabilization centers as emergency service providers for individuals with a psychiatric or substance use disorders. The legislation authorized self-referral and referrals from family members, schools, hospitals, community-based providers, mobile mental health crisis teams, crisis call centers, primary care doctors, law enforcement and private practitioners.
Washington recently enacted legislation (SB 5120) that authorized licensing crisis relief centers, which are required to be open 24 hours a day, 7 days a week. The facilities must accept patients from law enforcement, emergency medical services and self-referrals. Other states have provided funding for crisis centers, including Colorado, Connecticut, Oklahoma and Oregon.
Looking Ahead
Legislation to support and expand the crisis care continuum has been a hot topic for most legislatures in the past several years in response to the mental health crisis. With increasing funding and notable collaboration, including unanimous support of some measures, this is an issue that will likely continue to demand the attention of lawmakers and stakeholders from both the health and justice systems alike.