Measuring Whether Behavioral Health Crisis Systems Reach People in Need

Since passage of the American Rescue Plan Act in 2021, the United States has made significant investments in behavioral health crisis response systems, including the implementation of the 988 Suicide & Crisis Lifeline, enhanced Medicaid financing for mobile crisis services, and the expansion of Certified Community Behavioral Health Clinics. Most recently, HHS announced more than $700 million in additional behavioral health investments. As crisis response becomes a permanent component of the nation’s public health infrastructure, an increasingly important question is whether these investments are reaching the people they are intended to serve.

Many areas of health care evaluate performance by asking whether a health system reaches the population that needs its services, not just the people who enter care. Screening programs, vaccination, HIV care, and universal health coverage all distinguish the population in need from those who ultimately receive services. These efforts estimate coverage using population surveys, surveillance systems, registries, and administrative data. Behavioral health crisis systems face a similar challenge, yet routine evaluation remains largely centered on people who enter crisis services rather than the population experiencing crises.

Routine crisis-system reporting remains concentrated on people who contact a service and on the operations and outcomes of that service. The United States can report how many calls, texts, and chats reach the 988 Suicide & Crisis Lifeline, and how many are answered. Mobile crisis programs and their state or local authorities may track dispatches, response times, and connections to follow-up care, although practices vary substantially. By themselves, these service-based metrics cannot determine what proportion of all people experiencing behavioral health crises received an effective response or how many never accessed service.

This matters because people seek help through many pathways and many never reach specialty crisis services. In a nationally representative survey of US adults that we fielded in 2025, 8.9% reported experiencing what they considered a mental health crisis during the previous year. Among respondents who reported seeking help, health care providers and family or friends were the most commonly reported sources: fewer than one in five reported contacting 988, and approximately one in ten reported using a mobile crisis team. These estimates show that service metrics only capture a single part of the crisis-response landscape.

The United States should adapt the concept of “effective coverage” to behavioral health crisis systems. Effective coverage assesses whether people in need receive services of sufficient quality to achieve the intended health benefit. Behavioral health crises present an additional challenge because important failures may occur before people ever reach a formal crisis response, including failure to recognize a crisis, seek help, or successfully connect with an appropriate responder. Mental health researchers have previously argued that both contact coverage and effective coverage are necessary to assess whether services reach populations in need. Behavioral health crisis policy requires an adaptation of that principle to an urgent, episodic, multisector system.

No single data source can identify the full population experiencing behavioral health crises. As in many areas of public health surveillance, population-based measurement will require integrating complementary sources, each of which observes a different segment of the population. Household surveys can estimate crisis prevalence, unmet need, and barriers to care among people regardless of whether they seek services. Administrative records from 988, mobile crisis programs, emergency medical services, emergency departments, Medicaid, and law enforcement characterize the experiences of people who enter crisis-response systems. Mortality surveillance and other community data provide additional information on severe outcomes and populations that may be missed by either source alone. These data can support population-based estimates of crisis-system reach while identifying where opportunities for intervention are lost.

This framework would also expose inequalities that service-level averages can conceal. A high 988 answer rate says little about people who never call because they do not know about the service, cannot communicate in their language, distrust what will happen next, fear police or involuntary treatment, or live where downstream services are unavailable. Crisis-service volume can rise while population coverage falls if the number of people needing help grows more quickly than the number receiving an effective response. An HHS-sponsored report has already identified the National Survey on Drug Use and Health as one potential vehicle for estimating crisis-service need and unmet need. The next step is to measure not only whether help was needed and obtained, but also its timeliness, fit, voluntariness, immediate benefit, and continuity.

The United States is rapidly building a national behavioral health crisis system. Until it measures crisis coverage from need through response, resolution, and continuity, it will know how busy its crisis services are, but not whether those investments are reaching the people they are intended to serve. As crisis response becomes a permanent component of the nation’s public health infrastructure, it must also become accountable for the population it is intended to serve.

About the Author