Mapping Mental Health Emergency Response Systems: Assessing Capacity, Equity, and Impact Across the U.S.

Project Summary/Abstract 52 million individuals in the U.S. have mental health conditions. Fewer than half received treatment in the past year. Research indicates the U.S. has an ill-equipped and maldistributed mental health emergency response system (MHERS), stemming from underdeveloped infrastructure and a paucity of providers. Two key components of the MHERS are acute psychiatric beds and emergency hotlines such as the national 988 Suicide and Crisis Lifeline (988). The supply and distribution of MHERS resources throughout the U.S.—including psychiatric beds and 988 staffing—is poorly characterized. We propose to construct a longitudinal, nationally-representative inventory of each state’s MHERS, providing us with timely information corresponding to three aims: first, to quantify the evolving capacity of each MHERS, such that policymakers have up-to-date information on prospective investments; second, to examine inequities in availability of MHERS resources according to demographic and socioeconomic characteristics of local communities; and third, to relate geographic variation in MHERS capacity to population health outcomes, including deaths by suicide and mental health-related emergency department (ED) admissions. Over the project period, states including CA, TX, OH, and NY have pledged more than $U.S. 6 billion to overhaul their MHERS, providing a natural experiment within our study by which we can relate changes in MHERS capacity (i.e., number of psychiatric beds, 988 staffing) to population health outcomes (i.e., deaths by suicide, ED admissions). Achieving this effort depends on our ability to synthesize data from diverse primary and secondary sources, including: (i) state licensure data on acute psychiatric beds, (ii) a national survey of facilities with psychiatric beds to deduce characteristics such as bed occupancy rates and wait times, (iii) 988 metrics curated by Vibrant Emotional Health (Vibrant), (iv) a survey of 988 call centers to document staffing, and (v) data from secondary sources such as the Centers for Disease Control and Prevention’s National Vital Statistics. We have worked extensively with all relevant datasets, and we have strong relationships with agencies engaged in 988 metrics curation and 988 call center support. We also have deep experience conducting national surveys (including on facilities with psychiatric beds and 988 infrastructure), and we have led a prior statewide investigation of psychiatric bed capacity for California. Ultimately, this study will provide real-time information to states about the magnitude and distribution of shortages in their MHER systems. Corresponding to our third aim, we will also build a simulation model and online user interface that allows public officials and policymakers to examine the degree to which investments in their local jurisdictions would be expected to reduce ED admissions and deaths by suicide.