Taking the Lead

Investing in Community Crisis Response/Continuum


International Declaration:
Washington, D.C.
IIMHL/Crisis Now Academy 2 | September 2019


“Like a physical health crisis, a mental health crisis can be devastating for individuals, families and communities. Too often, that experience is met with delay, detainment and even denial of service that can all add to a person’s trauma history. While a crisis cannot be planned, we can plan how we organize services to meet the needs of those individuals who experience a mental health crisis. It can also lead to hope, recovery and action. It is the latter outcome this document seeks to promote.”

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An Open Letter in Response to the President’s Executive Order on Safe Policing for Safe Communities Section 4. Mental Health, Homelessness, and Addiction


We are encouraged by the focus of the President’s June 16th Executive Order on shifting responsibility to address the needs of individuals with mental illnesses and substance use disorders, and those experiencing homelessness, away from law enforcement to appropriate social service providers. However, increasing the capacity of social workers and other mental health professionals to work alongside law enforcement to co-respond to address situations does not go far enough in reducing the role of law enforcement.


Read the full letter here

National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit


The National Guidelines for Crisis Care – A Best Practice Toolkit advances national guidelines in crisis care within a toolkit that supports program design, development, implementation and continuous quality improvement efforts. It is intended to help mental health authorities, agency administrators, service providers, state and local leaders think through and develop the structure of crisis systems that meet community needs.


This document was produced for the Substance Abuse and Mental Health Services Administration (SAMHSA), and the U.S. Department of Health and Human Services (HHS).

Crisis Now Innovation Timeline

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Crisis Coding

Sustainable Funding for Mental Health Crisis Services

Best Practice Toolkit

SAMHSA’s National Guidelines for Behavioral Health Crisis Care

Be the Change

Ensuring an effective response to all



After reviewing approaches to crisis care across the United States, the Crisis Services Task Force of the National Action Alliance for Suicide Prevention (Action Alliance) believes now is the time for crisis care to change. The Task Force, established to advance objective 8.2 of the National Strategy for Suicide Prevention (NSSP), comprises many experts, including leaders who have built and operate many of the most acclaimed crisis programs in the nation

After reviewing the literature and model programs, these leaders built the Crisis Now report to suggest what can be done, galvanize interest, and provide a road map for change. Our comprehensive review finds that now is the time for crisis services to expand because of a confluence of factors and forces, including:



The Task Force has studied elements of successful programs and reviewed their effectiveness. While some communities are crisis-ready, there are very few communities where all key elements of crisis care are in place, and many where even the “parts” of crisis care that exist are inadequate. In short, core elements of crisis care include:

  1. Regional or statewide crisis call centers coordinating in real time
  2. Centrally deployed, 24/7 mobile crisis
  3. Short-term, “sub-acute” residential crisis stabilization programs
  4. Essential crisis care principles and practices
  5. Develop and implement protocols for delivering services for individuals with suicide risk in the most collaborative, responsive, and least restrictive setting
These elements are discussed in more detail in the report (download here). Effective crisis care that saves lives and dollars requires a systemic approach, and these key elements must be in place. The report also reviews proven key components of good crisis care and demonstrates that piecemeal solutions are unacceptable.

Four Core Elements For Transforming Crisis Services



These programs use technology for real-time coordination across a system of care and leverage big data for performance improvement and accountability across systems. At the same time, they provide high-touch support to individuals and families in crisis.



Mobile crisis offers outreach and support where people in crisis are. Programs should include contractually required response times and medical backup.



These programs offer short-term “sub-acute” care for individuals who need support and observation, but not ED holds or medical inpatient stay, at lower costs and without the overhead of hospital-based acute care.



These must include a recovery orientation, trauma-informed care, significant use of peer staff, a commitment to Zero Suicide/Suicide Safer Care, strong commitments to safety for consumers and staff, and collaboration with law enforcement.

Beyond Beds Crisis Continuum (NASMHPD)

Technical Assistance Coalition Assessment Working Papers

From Crisis to Care: Building from 988 and Beyond for Better Mental Health Outcomes
Ready to Respond, Mental Health Beyond Crisis and Covid-19
Crisis Services
Beyond the Borders
Bolder Goals
Beyond Beds

Featured Policy Papers

The Crisis Now Impact

Crisis Now saves time and operating costs by improving access to care.

Rate Your Local Crisis System

The assessment and programmatic scoring guide.

How Does Your Crisis System Rate?

The Crisis Now Report

Transforming services is within our reach

Recommendation 1

Crisis Call Services Should Participate in and Meet the Standards of the National Suicide Prevention Lifeline, and crisis Intervention Systems Should Adopt and Implement Zero Suicide/Suicide Safer Care Across all Program Elements

  • Leadership-driven, safety-oriented culture committed to dramatically reducing suicide among people under care, which includes survivors of suicide attempts and suicide loss in leadership and planning roles
  • Develop a competent, confident and caring work force
  • Systematically identify and assess suicide risk among people receiving care
  • Ensure every individual has a pathway to care that is both timely and adequate to meet his or her needs and that includes collaborative safety planning and reducing access to lethal means. Use effective, evidence-based treatments that directly target suicidal thoughts and behaviors
  • Provide continuous contact and support, especially after acute care
  • Apply a data-driven quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk

Recommendation 2

Effective Crisis Care Must Be Comprehensive and Include The Core Elements of Crisis Care

  • Regional or statewide crisis call centers coordinating in real time
  • Centrally deployed, 24/7 mobile crisis
  • Short-term sub-acute residential crisis stabilization programs
  • Essential crisis care principles and practices
  • Recovery orientation
    • Trauma-informed Care
    • Significant Use of peer staff
    • Commitment to Zero suicide/Suicide Safer Care
    • Strong commitment to safety of consumers and staff
    • Collaboration with law enforcement

Recommendation 3

State and National Authorities Should Review the Core Elements of Air Traffic Control Qualified Crisis Systems, Apply them to Crisis Care in their Jurisdictions, and Commit to Achieving These Capabilities Within 5 Years, So That Each Region of the U.S. has a Qualified Hub for Crisis Care:

Link mobile crisis and crisis beds to the call center. Use air traffic control objectives:

  • Always know where the individual in crisis is (in time and space) and never lose contact
  • Verify the hand-off has occurred and the individual in crisis is safely in the hands of another provider

Status Disposition for Intensive Referrals

  • 24/7 Outpatient Scheduling
  • Shared Bed Inventory Tracking
  • High-tech GPS-enabled Mobile Crisis Dispatch
  • Real-time Performance Outcome Dashboards

For additional information about the Crisis Now recommendations download the full report:

For additional crisis readiness strategies and documents check out the Crisis Now Library:

How Does Your Crisis System Flow?

Calculate Your Local Crisis Need

The volume estimation and clinical distribution guide.

How Does Your Crisis System Flow?

Crisis Now Video Library

It’s Been a Bad Day

The Crisis Now Impact

Crisis Now saves time and operating costs by improving access to care.

The Retreat Model is Today

Transforming Crisis Services in Arizona

Air Traffic Control Model

A Day in the Life… Mobile Crisis Teams

Crisis Providers Improve Care, Reduce Cost, And Relieve ER Overload


Good crisis care reduces and prevents suicides while providing more immediate and targeted help for the person in distress. In addition, it cuts cost of care substantially by reducing the need for psychiatric hospital bed usage, emergency department visits, and law enforcement overuse. In general, mental health crisis care in the U.S. is inconsistent and inadequate. Members of the Crisis Services Task Force of the National Action Alliance for Suicide Prevention (Action Alliance) created the Crisis Now concept and authored the Crisis Now paper; identifying the exceptional practices desired in a crisis services.

Responses to questions will be answered by representatives of agencies involved in the creation of the Crisis Now Report.

National Council for Mental Wellbeing
RI International
988 Suicide & Crisis Lifeline
National Association of State Mental Health Program Directors
National Action Alliance for Suicide Prevention
National Alliance on Mental Illness
CIT International, Inc.
Mental Health America, Inc.
Connections Health Solutions