As the demand for behavioral health crisis services continues to grow, it’s clear that communities need more than just additional psychiatric beds—they need fully integrated crisis systems that ensure people receive the right care at the right time. During our recent webinar, Dr. Margie Balfour and Chris Santarsiero explored how SAMHSA’s new guidelines, policy changes, and innovative crisis care models are shaping the future of behavioral health. 

Here are five key takeaways from the discussion:

1. The 988 crisis lifeline is transforming crisis response

Since its launch, the 988 Crisis Lifeline has catalyzed major improvements in behavioral health crisis care. Over 40 states are actively working to establish licensure and regulatory standards, and the number of crisis stabilization facilities and mobile crisis teams has expanded significantly. However, the rapid pace of adoption has led to inconsistencies in service definitions, care delivery, and funding models, creating barriers to access.

2. Crisis care must follow a “no wrong door” approach

Many communities investing in crisis centers still find emergency rooms and jails overwhelmed with individuals in crisis. This is because crisis care isn’t just about adding more beds—it’s about creating a seamless system that directs people to the least restrictive and most appropriate level of care. A "no wrong door" model ensures that anyone experiencing a crisis can get help without unnecessary delays, reducing the burden on law enforcement and hospital emergency departments.

3. SAMHSA’s updated guidelines provide a roadmap for effective crisis systems

To help states improve crisis care coordination, SAMHSA has introduced new national standards that clarify crisis facility definitions, care levels, and service expectations.  

Their framework distinguishes between: 

• No barrier or low barrier facilities: These centers accept walk-ins and emergency drop-offs—ensuring that anyone in crisis can receive immediate care, regardless of their background or financial situation.  
• Referral-based residential services: These facilities require pre-approval or referral before an individual can access care. They serve people who may need longer-term stabilization after an initial crisis. 
• Services for children, youth, and families: SAMHSA also emphasizes the need for specialized crisis services for youth, including Youth and Family Crisis Respite Care and In-Home Stabilization Services. 

4. Policy and funding reform are essential for long-term success

Scaling crisis services requires strong government partnerships at the county, state, and federal levels. Many states are implementing Medicaid reimbursement models that fund crisis services, while others have introduced 988 service fees on phone bills to ensure financial sustainability. As Medicaid remains the largest payer for mental health services, aligning state policies and funding streams is critical for ensuring long-term success. 

5. Crisis centers must be equipped to handle high-acuity cases

To truly reduce ER visits and incarceration rates, crisis centers must be prepared to serve high-acuity individuals—those experiencing severe agitation, involuntary psychiatric holds, or co-occurring substance use disorders. The most effective models include: 

• Emergency-level crisis stabilization units with medical and psychiatric capabilities. 

• Safe and therapeutic environments designed for de-escalation and rapid assessment. 

• Trained staff capable of handling acute crises without relying on security interventions. 

By expanding access to high-intensity crisis care, communities can divert individuals away from emergency rooms and jails, ensuring they receive the right care in the right setting. 

Looking ahead: the future of crisis care 

The conversation around behavioral health crisis response is evolving, and it’s clear that a well-coordinated system is the key to success. By leveraging SAMHSA’s guidelines, policy reform, and innovative crisis center models, communities can build stronger, more efficient crisis systems that improve outcomes for individuals in need. 

Want to learn more? Reach out to talk to an expert: hello@connectionshs.com and stay tuned for additional insights from the Connections team by following our blog.  

References 

Explore some of the resources Dr. Balfour and Chris referenced in the webinar: 

• Crisis Receiving and Stabilization Facilities: Designing Systems for High-Acuity Populations - ScienceDirect 
• Home | Crisis Roadmap 
• How to use the new SAMHSA guidelines