The behavioral health crisis continues to strain our healthcare system, communities, and most importantly, the individuals who need care most. In a recent webinar, Dr. Margie Balfour and Matt Miller critical insights from the Connections 2025 Behavioral Health True Costs Report, revealing both the devastating impact of a current broken system and the promising solutions emerging across the country.
1. The current system is failing everyone - especially those in crisisThe statistics are staggering: 18 hours average wait time for a psychiatric patient to be seen at a hospital, with ED boarding costing an approximate of $2,700 per day. Meanwhile, 56.5% of all healthcare costs are attributed to those with behavioral health conditions.
Our crisis response system inappropriately relies on emergency departments that are ill-equipped to treat behavioral health emergencies, or worse, jails and detention centers that aren't equipped to treat crisis at all. This misalignment creates a vicious cycle of inadequate care, higher costs, and worse outcomes for everyone involved.
2. Crisis systems work - when they're built rightThe solution isn't to replace existing behavioral health services, but to build a comprehensive crisis system that enhances them. Research from Arizona shows that when proper crisis systems exist, 69% of people remain in the crisis system rather than being transferred to costly emergency departments or hospitals.
Even more encouraging: 63% of individuals don't reuse crisis or emergency services within 30 days, and of those who do need additional care, 73% return to crisis settings rather than emergency rooms. This demonstrates that people will use crisis systems when they're available - and they work.
3. High-acuity centers are game-changers
SAMHSA's new standardized definitions for crisis care levels have created clarity around what communities need most: high-intensity behavioral health emergency centers that can handle anyone, regardless of how agitated or involuntary they might be.
These specialized centers serve as "sorting hats" for the crisis system, providing immediate stabilization for high-acuity patients while stepping down others to appropriate levels of care. The result? 60% of involuntary patients improve enough to convert to voluntary treatment, dramatically improving engagement and outcomes.
4. Momentum is building nationwide
The regulatory landscape is rapidly shifting. From 2022 to 2025, the number of states with crisis service licensure or regulation jumped from roughly a dozen to more than 40 states that have adopted or are moving toward specific crisis service regulations.
We're also seeing remarkable growth in crisis infrastructure: 128% increase in 988 crisis lines and 108% increase in crisis stabilization centers. This isn't just policy change - it's a fundamental shift in how America approaches behavioral health emergencies.
5. Sustainable funding models are emergingThe key to sustainable crisis systems lies in braided funding approaches that combine SAMHSA block grants, state dollars, Medicaid, and even private insurance. States like Washington and Arizona have created models where funding flows to crisis providers, eliminating the burden of managing multiple contracts.
The return on investment is significant. Arizona's analysis highlights that communities that invest into crisis services see substantial avoided costs in inpatient care, reduced psychiatric boarding, and even law enforcement savings - translating to more officers back on the street rather than waiting in emergency departments.
The path forward
Building effective crisis systems requires four key principles: investing in comprehensive crisis elements, building partnerships across healthcare and public safety, exploring innovative funding relationships, and promoting supportive policy at all levels of government.
As Matt Miller noted, "This should not be viewed as a cost-plus service. Is there some investment? Sure, absolutely investment upfront, but the dividends are significant once those initial investments are made."
The evidence is clear: crisis systems work, they save money, and they save lives. The question isn't whether we can afford to build them - it's whether we can afford not to.
For more detailed insights and data from the 2025 True Cost Report, watch the full webinar recording or download the full report.
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