Crisis Services Struggle to Meet Increased Need Generated From Launch of 988

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According to a new study from RAND, the launch of the 988 mental health hotline did not coincide with significant, equitable growth in the availability of most crisis services, except for a small increase in peer support services.¹

Investigators examined reports from thousands of mental health treatment facilities about crisis services offered before and after the July 2022 rollout of the 988 hotline. They found that there was an increase in peer support services, a significant decrease in psychiatric walk-in services, and small decreases in mobile crisis response and suicide prevention services. There was significant variation across states in service availability trends both before and after 988. The findings are published in the journal JAMA Psychiatry.²

“The lack of meaningful growth in most crisis services may limit the long-run success of 988, in particular if callers feel that reaching out to 988 fails to result in access to appropriate sources of care,” said Jonathan Cantor, lead author of the study and a policy researcher at RAND.

Despite the increased demand prompted by utilization of 988, mental health emergency response services may not be equipped to handle an increase of patients. In the first year alone, 988 received over 5 million contatcs, including more than 1.43 million calls, 416,000 chats, and 281,000 texts.³

RAND investigators sought to better establish this issue by evaluating the availability of crisis services offered by mental health treatment facilities throughout the US from November 2021 through June 2023.

Investigators utilized data from a large sample of reports from more than 15,000 mental health treatment facilities nationally. Peer support services saw the largest increase; it was available at 39% of facilities prior to 988 and available at 42% of facilities after. On the other hand, availability of emergency psychiatric walk-in services saw the largest decrease; it was available at 32% of facilities prior to 988 and available at 29% of facilities after. Other service types at mental health treatment facilities also saw declines at the national level. Mobile crisis response and suicide prevention services both saw a 1% decrease: from 22% to 21% after 988 for mobile crisis response, and 69% to 68% after 988 for suicide prevention services.

There were also significant differences observed in crisis service availability based on type of facility. For example, public facilities had the highest likelihood of offering each of the 4 crisis services, followed by not-for-profit facilities. For-profit facilities (25% of the sample) consistently had the most-limited services.

Suicide prevention services at the state-level remained the same for most states over the course of the study. The largest increase in the availability of suicide prevention services was seen in Montana (11.5% increase), and the largest decline in availability was in Rhode Island (11.4% decrease). In general, most states experienced an increase in the number of facilities offering peer support services. The largest gain in offering of peer support services was in Kansas (19.6% increase) and the largest decline in peer support services was found in Georgia (3.2% decrease).

“Mental health officials and policymakers should consider strategies to boost the financing and availability of crisis services at mental health treatment facilities to meet increased demand generated by the 988 Suicide and Crisis Lifeline,” Cantor said.

Support for the study came from the National Institute of Mental Health. Other authors of the study are Megan S. Schuler, Rose Kerber and Ryan K. McBain, all of RAND, and Jonathan Purtle of New York University.

References

1. Most mental health crisis services did not increase following launch of 988 crisis hotline. News release. January 29, 2025. https://www.rand.org/news/press/2025/01/29.html

2. Cantor J, Schuler MS, Kerber R, et al. Changes in specialty crisis services offered before and after the launch of the 988 Suicide and Crisis Lifeline. JAMA Psychiatry. 2025.

3. Kuntz L. A year of 988: the first step in a long journey. Psychiatric Times. 2023;40(7).