Trending Topics

Suicide prevention through the 988 Mental Health Crisis Initiative

Collaboration between EMS and community resources is key to creating a stronger network of mental health crisis response

Suicide is always preventable. If you are having thoughts of suicide or feeling suicidal, please call the National Suicide Prevention Hotline immediately at 988. Counselors are also available to chat at Remember: You deserve to be supported, and it is never too late to seek help. Speak with someone today.

NEW ORLEANS — Effectively connecting essential resources to those who need them most challenges mental health crisis response within our communities. Historically, EMS has shouldered the responsibility for initial response in mental health crisis incidents.

Kate Elkins, MPH, CPH, NRP, CHES; an active 26-year volunteer paramedic with NHTSA Office of EMS and the National 911 Program presented a session titled “Changing EMS from a safety net to a partner in crisis response” during the 2023 EMS World Expo to explain the benefits of the new 988 Suicide and Crisis Lifeline and the continued need for partnerships to enhance our communities’ ability to prevent and respond to crises effectively.


Here are some memorable quotes from Elkins on mental health crisis prevention and response:

“We have to build up the system. We have to build up these resources. And this is going to take some time.”

“We need to transition to being an interoperable system of systems that work together.”

“Let’s start having more conversations so we engage in more research.”


The impact of suicide cannot be overstated. For Elkins, it hits all too close to home, as she has tragically lost 11 of her peers to suicide. This grim reality highlights an urgent call to action to improve first responder mental health resources, as well as to identify current challenges in an effort to improve mental health response through collaboration initiatives on a national and local scale.

Here are the key takeaways from Elkins’ presentation on mental health crisis prevention and response.

1. The emergence of mental health crisis initiatives

Recently, a transformation of the 988 Suicide & Crisis Lifeline was implemented on a national level by the Federal Communications Commission, supported by the Substance Abuse and Mental Health Services Administration, and the National Highway Traffic Safety Administration Office of EMS. This renewal recognizes that people in crisis need immediate assistance, similar to calling 911 for medical emergencies.

2. Challenges in implementation

The 988 lifeline is designed to provide nationwide support for individuals experiencing mental health crises, allowing access to crisis intervention teams while maintaining confidentiality.

While the 988 lifeline implementation holds immense promise, there are still several challenges.

One of the primary obstacles is the necessity for an adequate workforce to handle calls. Just as 911 centers and EMS providers require skilled and compassionate staff ready to respond to crisis calls effectively, 988 call centers must meet this requirement as well. Furthermore, there is a pressing need for collaboration among various stakeholders, including EMS, law enforcement and mental health professionals, to ensure seamless crisis management.

Routing calls to the appropriate centers is another significant challenge. Unlike 911, which automatically relays location information, 988 currently relies on area codes for routing. This can lead to delays and misdirection of calls, especially in regions with overlapping area codes. To improve efficiency, the FCC is exploring options for location-based routing while ensuring continued anonymity for callers.

3. Collaboration through EMS providers and community resources

A critical aspect of addressing mental health crises is the enhancement of collaboration and interoperability among various agencies and organizations within the community. Today, new initiatives include collaboration between EMS providers and community resources to create a comprehensive approach to respond effectively to mental health crisis incidents involving their residents. Co-responder models, involving police, fire, EMS and mental health specialists are emerging as ways to address mental health crises efficiently.

Here are a few examples of current innovative crisis response programs within EMS agencies around the country.

  • The Austin-Travis EMS County, Texas, Community Health Paramedic (CHP) Scene Response Program has launched innovative initiatives to provide alternative response resources to residents experiencing mental health crises. In collaboration with the 911 Communication Center and the Expanded Mobile Crisis Outreach Team (EMCOT), CHP Behavioral Health Paramedics are on call 24/7 to answer the call for assistance. These providers receive specialized training in de-escalation techniques, effective communication skills and comprehensive knowledge of available local resources to address housing concerns, medications and substance abuse.
  • St. Charles EMS Mobile Integrated Healthcare team, located in Missouri, was recently awarded a $1.5 million SAMHSA grant over the next 4 years, enhancing their ability to provide assistance to residents seeking treatment for substance abuse and mental health services. Elkins explains their EMS providers have a direct link to master’s level social workers via telehealth with a “no wait approach,” who can assist in directing patients to local resources.
  • Utah Navajo Health System EMS, located in Montezuma Creek, earned the 2022 EMS World Volunteer EMS Service of the Year Award in recognition of their commitment to their rural community. Their dedication embodies a comprehensive approach, which includes ensuring that all EMS providers complete the Applied Suicide Interventions Skills Training (ASIST), a 2-day training course designed to equip them with the skills to assist individuals at risk for suicide.

EMS clinicians, along with their colleagues in law enforcement and mental health services, have a pivotal role in preventing crises, providing immediate assistance, and connecting individuals with local resources best suited to their needs.

4. The role of research

Research plays a pivotal role in understanding and addressing mental health challenges. Engaging in research and resource development helps refine crisis response strategies and bridge gaps in mental health services. Elkins emphasized the pressing need to participate in and support research efforts, so we can better understand the unique needs of our populations.

Elkins stressed the importance of the role of EMS in the mental health crisis is expanding beyond traditional medical emergencies. The 988 mental health crisis initiative represents a significant step forward in addressing the growing mental health crisis in the United States. However, it is not without its challenges, which require the collective efforts of communities, agencies and individuals. By working together, advocating for change, engaging in research and fostering collaboration, we can build a more robust and effective mental health crisis response system. In doing so, we can save lives and offer hope to those in their darkest moments.


  1. Auten, B. (2023, September 1). Healing Body and Mind: The St. Charles County Ambulance District’s Substance Use Recovery Response Team Battles the Ongoing Mental Health Crises and Opiate Epidemic. Community News Crossroads Magazine.
  2. Carson, L. M., Marsh, S. M., Brown, M. M., Elkins, K. L., & Tiesman, H. M. (2023). An analysis of suicides among first responders ─ Findings from the National Violent Death Reporting System, 2015–2017. Journal of Safety Research, 85, 361-370.
  3. EMS Collaboration with Public Safety, Emergency Management & Health Disciplines. Website: powered by NHTSA.
  4. Kurwicki, H. (2023, September 6). St. Charles County Medication Withdrawal Treatment. KSDK.

Additional resources

Nicole M. Volpi, PhD, NRP, has experience in emergency medical services, law enforcement, military/civilian disaster response and disaster management research. She currently works full-time as a paramedic, preceptor, and emergency management disaster liaison for a hospital-based emergency medical service in Marrero, Louisiana.

She serves as one of the Louisiana Department of Health Region One EMS designated regional coordinators within the southeast area, responding to various emergencies where EMS support is needed or requested on a local/state level.

She has a PhD from Capella University in Public Safety/Emergency Management and a master’s degree in Criminal Justice/Law Enforcement Administration from Loyola University in New Orleans.