SAMHSA and CMS Release Updated Best Practices for Implementing Effective Crisis Services

Why Do Communities Need a Comprehensive Crisis System of Care? 

A comprehensive crisis system of care is pivotal for addressing the sudden, unexpected and acute behavioral health needs of individuals; including those experiencing a first episode of psychosis. Recent data underscores the escalating mental health crises; for instance, in 2024, 5.5% of adults had serious thoughts of suicide, and over 49,000 people died by suicide in 2023. An effective crisis system of care can significantly prevent, respond and stabilize crises by providing timely, evidence-based support and intervention.

On September 5, 2025, CMS and SAMHSA released updated guidance that doubles down on the need for an integrated crisis systems of care that includes (a) someone to contact, (b) someone to respond, and (c) a safe place for help. This structured approach ensures that individuals in crisis receive immediate and appropriate care, reducing the reliance on emergency departments and improving overall mental health outcomes.

Key Elements of Effective Crisis Response

A robust crisis response system involves several key elements:

1. Someone to Contact: The 988 Suicide & Crisis Lifeline, other hotlines (e.g. disaster response), peer support warmlines, and emotional support lines (e.g. family support lines) offer accessible support to individuals in crisis and their loved ones. These telehealth solutions may include text and chat and are critical for suicide prevention and provide a gateway to further services.

2. Someone to Respond: Mobile crisis teams  provide on-demand, community-based intervention. There are numerous effective models nationally, including volunteer and paid-professional run programs that consist of only behavioral health practitioners, co-responders models with law enforcement, specialized youth and family crisis teams; and community outreach teams that focus on addressing unmet health related social needs. Mobile crisis teams perform risk assessments, offer stabilization supports, and facilitate linkages to higher levels of care when needed.

3. A Safe Place for Help: When crises can not be safely stabilized in the home and community, crisis systems of care need a safe place for people to get help. These facility-based crisis supports can include: moderate intensity services that are voluntary only, behavioral health urgent cares that offer care voluntarily or involuntarily, peer crisis respite, sobering centers, crisis residential treatment, community crisis respite, youth and family crisis respite and emerging in-home stabilization services. These levels of care divert individuals to treatment and away from incarceration and emergency departments. Ensuring access to these services is essential for effective crisis management.

Financing Options for Sustainable Crisis Services

The updated guidance also reviews sustainable financing options available to States through their Medicaid and CHIP programs; including: 

• State Plan Benefits: States can use optional benefits like rehabilitative services and other licensed practitioner services to cover a wide range of crisis services.
• Home and Community-Based Services (HCBS): Sections 1915(c) and 1915(i) allow states to cover crisis services for individuals who prefer to receive care in their homes or communities.
• Health Homes: Section 1945 of the Act enables states to offer health home services to Medicaid-eligible beneficiaries with chronic conditions, including mental health and substance use disorders.
• Section 1115 Demonstration Projects: States can seek demonstration authority to offer a continuum of crisis services, including SUD and serious mental illness/emotional disturbance demonstrations.
• Certified Community Behavioral Health Clinics (CCBHC) Demonstrations: These clinics provide comprehensive behavioral health services, including crisis services, under a prospective payment system.
• Presumptive Eligibility: States have the option the include those experiencing a crisis in the presumptive eligibility option, enabling timely access to care. 
• Managed Care Flexibilities: Managed care organizations may elect to offer crisis system of care services through value-added benefits and in lieu of services. 
• Administrative Claims. Medicaid and CHIP programs can cover the cost of crisis system of care services through their administrative claims options, offering sustainable funding for these critical services. 

Strategies for Monitoring and Evaluation

Effective monitoring and evaluation are essential for ensuring the quality and efficiency of crisis services. Key strategies include:

• Data Governance and Interoperability: Establishing robust data governance frameworks and ensuring interoperability between systems can enhance the quality of care.
• Program Evaluation: Regular program evaluations help identify areas for improvement and measure the impact of crisis services.

Insights from Hess III Consulting’s Work Designing Crisis Systems of Care

Hess III Consulting brings over 15 years of experience in designing, implementing, and optimizing psychiatric crisis systems including crisis call centers, mobile teams, stabilization units, inpatient facilities, and involuntary treatment in Arizona, Arkansas, Georgia, Idaho, Louisiana, Nevada, North Carolina, Pennsylvania, Virginia, and Washington. Our experience illuminates additional best practices for comprehensive crisis systems of care: 

• “Air Traffic Control” real time monitoring through the continuum of crisis services. Through data governance and interoperability, communities and states are introducing technology that offers digital continuity of care as individuals move through the crisis system of care. This technology 'follows the person' as they engage with mobile crisis teams, access facility-based care, and are connected back to on-going treatment providers; supporting timely follow-up. 
• Community bed board. Often included in air traffic control technology, community bed boards enable crisis systems of care to quickly identify open beds including crisis respite, residential treatment, stabilization units, inpatient facilities etc. In the future, we expect these will be connected to permanent supportive housing platforms to support on-going stabilization through a housing first approach. 
• Health Related Social Need (HRSN) closed loop referral system. Crises often include unmet HRSN. By embedding closed loop referral systems into the crisis system of care, communities can quickly address these unmet needs, helping resolve the crisis. 
• Crisis Intervention Team (CIT) training. CIT meaningfully engages law enforcement and first responders to identify and understand psychiatric crises. It is best practice for CIT to include 911 dispatchers, law enforcement, paramedics/EMTs and even emergency department staff to support effective engagement and crisis stabilization. 
• Certified Peer Support Services. The evidence is clear, Certified Peer Support Specialists, with first-hand experience navigating their own mental health crises are the best suited to effectively engage others experiencing a crisis. Including Peers in crisis call centers, mobile teams, in facility-based services and follow-up care transforms crisis systems. 
• Family engagement. Crisis systems must be family-centered to support continued stabilization. This includes maximizing flexibilities under HIPAA and 42 C.F.R. for families to contribute medical and family history, helping families understand and navigate the crisis system of care, behavioral health system of care and justice system(s) when applicable. 
• Probate and mental health court coordination. Probate courts oversee legal guardianship, including for those incapacitated due to mental illness; and mental health courts oversee court ordered, involuntary treatment. These critical stakeholders must be included in crisis system design, data sharing and interoperability, and process optimization. 

By following these strategies and leveraging the insights from Hess III Consulting, communities and states can implement effective crisis services that improve outcomes for individuals experiencing behavioral health crises.