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Strengthening the Behavioral Health Crisis Workforce: Building Capacity and Sustainability

Our nation's behavioral health crisis response system is the front door to care, delivering immediate, life-saving support to people experiencing mental health and substance use crises. As demand continues to grow, the crisis workforce (including 988 counselors, mobile crisis teams, stabilization providers, peer specialists, supervisors and clinical leaders) serves as a critical alternative to emergency departments and law enforcement. However, rising service volume has outpaced workforce capacity, contributing to staffing shortages, burnout, and turnover that threaten system sustainability and effectivness.

Workforce Challenges

The behavioral health crisis workforce faces persistent recruitment, retention, and capacity challenges, including: 

  • Limited pipeline of workers trained in crisis response
  • Competition with higher paying health systems
  • Licensing and credentialing obstacles
  • Low awareness of crisis career pathways
  • Burnout, compassion fatigue, and secondary traumatic stress
  • Limited advancement pathways or consistent supervision and support
  • Severe shortages in rural and frontier communities
  • Limited standardized workforce data for planning and investment
System-Level Strategies For Building & Sustaining The Crisis Workforce

Strengthening the behavioral health crisis workforce requires coordinated policy, financing, and infrastructure strategies. States, Tribes, and Territories can leverage the following system-level actions:

Strengthen and Align Crisis Care Financing

The crisis care continuum is financed by a mix of federal, state, and local dollars, public and commercial insurance, and grants.

  • Align Medicaid reimbursement to cover the full crisis continuum
  • Use special tax levies like 988 cell phone surcharges
  • Leverage Substance Abuse and Mental Health Services Administration (SAMHSA) Mental Health Block Grants
  • Explore state plan amendments, Medicaid waivers, and other authorities
  • Partner with Certified Community Behavioral Health Clinics (CCBHCs)

Improve Retention Through Supervision and Workforce Supports

Retention requires structured supports that address the high-intensity nature of crisis work.

  • Provide ongoing clinical supervision and leadership development
  • Implement trauma-informed workplace practices
  • Invest in burnout prevention and workforce wellness strategies

Fully Integrate and Sustain Peer Support Roles

Peer support specialists can strengthen crisis response capacity

  • Integrate peers across the crisis continuum
  • Ensure competitive compensation and crisis certification programs
  • Promote peer leadership and supervision structures

Modernize Technology, Data, and Cross-System Coordination

Technology and data infrastructure are essential for efficient operations, accountability, and coordinated crisis to response.

  • Upgrade contact center and mobile crisis technology systems
  • Standardize workforce and service data collection
  • Use data to inform staffing models and funding decisions
  • Strengthen 988-911 interoperability through shared protocols and cross-training

Invest in Workforce Development and Career Pathways

A sustainable crisis workforce depends on clear, accessible pathways into crisis roles and opportunities for advancement.

  • Fund scholarships, loan repayment, and professional development
  • Develop targeted recruitment strategies for rural, frontier, and Tribal communities
  • Expand crisis-specific training partnerships and implement recruitment and retention strategies, including competitive pay, flexible scheduling, and remote work options
  • Establish credentialing pathways and career ladders
New Federal Framework: SAMHSA Model Standards for Crisis Care Workers

SAMHDA's National Model Standards for Crisis Care Workers provide a national framework to support many of the workforce strategies outlined above, including certification, credentialing, supervision, and billable service delivery across the crisis continuum. The Standards establish core competencies, education and training expectations, practice guidelines for both degreed and non-degreed providers.

The Standards support Medicaid and other prayer reimbursement and align with the 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care. They are designed to mitigate obstacles to workforce expansion while promoting quality and consistency across the crisis care continuum.

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