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As U.S. Launches New Crisis Hotline, Nearly Half of Counties Lack Response Teams

Yale Public Health Magazine, Yale Public Health: Fall 2022
by Ashley Liebre


A new 988 Suicide and Crisis Lifeline launched by the U.S. government is supposed to make it easier for people experiencing a mental health crisis to get help. But a Yale School of Public Health study has found that not all Americans will have the same access to appropriate follow-up care.

The 988 Lifeline, which went into effect on July 16, replaces the National Suicide Prevention Lifeline and offers expanded services, including support for people struggling with substance use and other behavioral health issues. The Lifeline is intended to direct calls to mental professionals—including crisis intervention teams (CIT) if necessary—rather than law enforcement.

While most callers’ needs can be met over the phone, 10% to 20% of calls require an in-person response to further assess the situation or transfer the caller to an appropriate care facility if necessary, according to the Yale study. But not all U.S. communities have access to crisis teams to provide that critical in-person support. 

A study by researchers at YSPH found that nearly half of all U.S. counties—1,512 of 3,142 (48%)—lacked access to a facility providing community CIT services in 2020. While almost 90% of U.S. residents live in a county with access to CIT, 1 in 9 U.S. residents live in counties without access to these services. The problem is particularly acute in rural areas. Researchers found that counties without access to crisis intervention teams tended to have a greater percentage of older and uninsured residents. They also were the counties with higher suicide mortality rates.

“This is concerning because rural America has some of the highest suicide rates and significant mental health needs,” said Helen Newton, MPH, PhD, a YSPH postdoctoral fellow and the study’s lead author. The study appears in JAMA Network Open

The cross-sectional study looked at 10,591 mental health treatment facilities in all 3,142 counties across the 50 U.S. states and the District of Columbia that were listed in the 2020 National Directory of Mental Health Treatment Facilities, which is maintained by the U.S. Substance Abuse and Mental Health Services Administration. The directory notes which facilities offer a crisis intervention team. The authors identified the counties in which those facilities were located as of 2015 and 2020, respectively. They then assessed how access to crisis intervention teams was associated with regional social and demographic characteristics and state Medicaid policies.

The new 988 Lifeline is expected to increase demand for community behavioral health services, which was already on the rise prior to COVID-19, according to the American Hospital Association. The AHA estimates that 21% of U.S. adults (some 52 million people) have mental, behavioral, or emotional disorders.