Supporting an Integrated, Sustainable, and Equitable Crisis Care System for Substance Abuse and Mental Health Services Administration’s (SAMHSA) 988 and Behavioral Health Crisis Coordinating Office    

In 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) selected Altarum to provide training and technical assistance (TTA) support to States, Tribes, and Territories across the 988 Suicide and Crisis Lifeline. Altarum’s national Crisis Systems Response Training and Technical Assistance Center (CSR-TTAC) supports a crisis care system that is integrated, sustainable, equitable, and aligned with evidence-based practices. 

In 2019–2020, over 50 million American adults were experiencing a mental illness, though over half of them did not receive treatment.1 The Covid-19 pandemic exacerbated rising rates of suicide and substance use disorder, making the need for robust crisis services greater than ever.

In 2020, Congress designated 988 as the three-digit “universal number for a national suicide prevention and mental health crisis hotline.” In 2021, state leaders cited multiple barriers to effective 988 and crisis system implementation, including workforce shortages, lack of infrastructure, challenges in meeting the needs of diverse populations, and limited collaboration across law enforcement and emergency medical and mental health services.

Health disparities and lack of resources lead many individuals in mental health crisis to interact with law enforcement instead of with mental health providers. 

“I worked in the field for 12 years, and police officers see more mental health crises than any therapist I’ve met,” says Adalicia Carrillo, Altarum’s Co-Director of the CSR-TTAC. “One of the first things that we are doing is supporting work to help States, Territories, and Tribal organizations create a foundation of collaboration between 988 and 911,” says Carrillo.

Central to our work, Altarum’s team of experts from multiple sectors evaluates the TTA needs of SAMHSA’s grant recipients and the broader behavioral health crisis field and helps States address barriers to implementing an effective “no-wrong-door” integrated crisis system. 

Altarum is collaborating with two woman- and minority-owned small business partners for the project: W2 Consulting Corporation and Change Matrix, LLC. Both have extensive experience with crisis services, technical assistance, and health equity.

To support the 988 Lifeline and build a more robust care system, Altarum’s TTAC will increase access to crisis services for those in need, convene experts to educate the field on best practices, and develop materials to help improve crisis services. Altarum will offer TTA through several formats to accommodate different types of learning styles, including collaborative webinars, office hours, learning communities, workshops, site visits, convenings, and specialized one-on-one TTA. Altarum and the CSR-TTAC will host a policy academy for States, Territories, and Tribal organizations to bring their leadership together to plan strategies for enhancing collaboration among partners in their behavioral health crisis system.  

“We work on large system integration, but also factor in local and state integration,” says Carrillo. “As we work to standardize services, we also must focus on equity—for example, ensuring access to crisis care in Tribal or rural communities where an urban model of crisis care might not be appropriate.”

Altarum brings 25 years of behavioral health TTA experience to the CSR-TTAC, having led similar tasks for two national TTA centers, including SAMHSA’s Access to Recovery TTA Center. 

“The backgrounds of the Altarum team members are really representative of the skills required to provide support throughout the crisis continuum of care,” Carrillo says.

The goal for the CSR-TTAC is to serve as a bridge between SAMHSA and the behavioral health crisis field, to learn what the field needs and provide that TTA to the field, and to identify and disseminate best and promising practices. The CSR-TTAC will help SAMHSA realize its vision of providing individuals in crisis someone to talk to, someone to respond, and a safe place to go for help. 

1Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health  Statistics and Quality, Substance Abuse and Mental Health Services Administration.