Changes in Specialty Crisis Services Offered before and after the Launch of the 988 Suicide and Crisis Lifeline

Importance: The launch of the 988 Suicide and Crisis Lifeline (988) in July 2022 aimed to enhance access to crisis mental health services by replacing the National Suicide Prevention Lifeline with a more memorable number and expanding the Lifeline scope beyond suicide. However, 988's success relies on the availability of community crisis services. Objective: To examine whether the launch of 988 was associated with the availability of crisis services. Design, Setting, and Participants: This cohort study characterized trends in crisis services offered by US mental health treatment facilities (MHTFs) from November 1, 2021, through June 30, 2023. Longitudinal data were from the Mental Health and Addiction Treatment Tracking Repository, which contains daily instances from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Locator. The analysis includes licensed MHTFs that completed the National Substance Use and Mental Health Services Survey. Proportions of facilities offering 4 specific crisis services were calculated nationally and at the state level. Mixed-effects logistic regression was used to assess changes in availability of each crisis service after the launch of 988, controlling for MHTF characteristics. Exposure: Launch of 988 in July 2022. Main Outcomes and Measures: Outcomes were the availability of mobile crisis response services, psychiatric emergency walk-in services, suicide prevention services, or peer support services. Results: Across 15623 MHTFs (184769 observations; 79268 before and 105501 after the 988 launch), the largest changes were observed for availability of peer support services, which increased from 39% (n = 31170) before to 42% (n = 44630) after the 988 launch (P <.001), and emergency psychiatric walk-in services, which decreased from 32% (n = 25684) before to 29% (n = 30300) after the 988 launch (P <.001). When controlling for MHTF characteristics, after the 988 launch, the odds of peer support availability increased 1.3% per month (odds ratio, 1.013; 95% CI, 1.009-1.018), and the odds of emergency psychiatric walk-in service availability decreased by 0.6% per month (odds ratio, 0.994; 95% CI, 0.989-0.999). Availability of other service types also decreased at the national level, with mobile crisis response decreasing from 22% (n = 17071) before to 21% (n = 22023) after the 988 launch and suicide prevention decreasing from 69% (n = 54933) before to 68% (n = 71905) after the 988 launch. Significant variation across states was observed in service availability trends before and after the 988 launch. Conclusions and Relevance: This study found that the launch of 988 did not coincide with significant and equitable growth in the availability of most crisis services except for a small increase in peer support services. These findings suggest that strategies are needed to boost the financing and availability of crisis services to reduce disparities and increase 988's likelihood of success.