Are We Reaching People in Crisis — or Just Counting the Ones Who Call?
Billions were spent on the 988 lifeline, but fewer than 1 in 5 people in crisis use it. Here is what research reveals about the gap in mental health care.
The U.S. has invested heavily in behavioral health crisis response since the passage of the American Rescue Plan Act in 2021, launching the 988 Lifeline, expanding mobile crisis teams and clinics and, most recently, releasing $700 million in grant funds previously approved by Congress to combat addiction and homelessness resulting from untreated mental illness.
Whether any unresolved issues remain unaddressed is a vital inquiry that Dr. Andrew Anderson, associate director at Partners for Advancing Health Equity at the Tulane School of Public Health and Tropical Medicine and a professor in the Johns Hopkins Bloomberg School of Public Health, is exploring through his current research.
Research shows that plenty of people reach out for resources and support, but a blind spot remains, Anderson argues in an op-ed for The Milbank Quarterly. Tracking how many people in crisis asked for help doesn’t measure how many of those who needed assistance actually received it. Worrying preliminary analyses suggest that the gap is wide.
In a 2025 nationally representative survey that Anderson helped administer, 8.9% of U.S. adults reported experiencing what they considered a mental health crisis within the past year. Among those who sought help, most turned to doctors, family or friends — fewer than one in five called the 988 hotline.
Anderson’s suggested fix is to apply the concept of “effective coverage,” derived from other sectors of healthcare, to mental health. It examines whether help was requested and whether the care they received had its intended effect. The deeper examination reveals more about the people who never call — because they don’t know 988 exists, can’t access care due to language or location barriers or fear police (or ICE) showing up to their door.
“The United States is rapidly building a national behavioral health crisis system,” Anderson writes. “Until it measures crisis coverage from need through response, resolution, and continuity, it will know how busy its crisis services are, but not whether those investments are reaching the people they are intended to serve.” That’s a gap in care that needs to change.
The name “MindSite News” is used with the express permission of Mindsight Institute, an educational organization offering online learning and in-person workshops in the field of mental health and wellbeing. MindSite News and Mindsight Institute are separate, unaffiliated entities that are aligned in making science accessible and promoting mental health globally.
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