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COVID-19: Behavioral Health Core Crisis Continuum as Essential Services

COVID-19: Behavioral Health Core Crisis Continuum as Essential Services

Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at​

It was December 2010, and Atlanta, Georgia was experiencing a once-in-a-hundred year ice storm that created chaos on the roadways and forced many businesses to shutter. The brand-new CEO at Behavioral Health Link (BHL) explained that the crisis call center would also need to close, and reported that the health plan call centers had already sent workers home earlier in the day. Gregg Graham, the crisis and access line’s founder, asked if Fulton County 9-1-1 was also closing. It was not.

Learning fast, the new BHL leader activated supervisors on identifying staff members who could stay over, finding available hotel rooms, working on safe transport options, and coordinating remote work from home capabilities. The Georgia Crisis and Access Line was an essential service, and it needed to continue fully just like hospitals, ambulance service, law enforcement, and fire.

Essential Services During COVID-19 Emergency Orders

With states across the country issuing work from home orders for non-essential employees due to the COVID-19 pandemic, Dr. John Draper with the National Suicide Prevention Lifeline network began issuing letters to crisis centers. He explains that essential services are “typically defined as functions so vital that the interruption or termination of these functions will constitute a clear and present danger to the health and safety of the persons in the affected community.”

Dr. Draper and the team at Vibrant Emotional Health know these challenges intimately. They led the mental health disaster response in New York City after 9/11 and worked to patch together additional capacity for the national disaster support line when hundreds of thousands were forced to evacuate Louisiana and Mississippi after Hurricane Katrina. The vital services at the crisis call center in New Orleans were knocked offline as the campus was flooded creating national repercussions and gaps.

His letter explains that independent evaluations of crisis centers have shown that many callers to the service experience significant reductions in emotional distress and suicidality by the end of the call. This positive impact remains for up to three weeks after the call. Accessible and free mental health crisis services represent vital services during the current COVID-19 outbreak. Dr. Draper writes, “When individuals may be experiencing heightened anxiety, depression, and stress caused by infectious disease outbreaks and accompanying social isolation measures, having access to trained, caring counselors may be critical for a community’s mental well-being.”

Broader View of Essential Services

When Washington State Governor Jay Inslee issued a stay at home order on March 23rd, he explained that thousands of essential workers would need to continue supporting their communities. The News Tribune reported, “The governor’s office released categories of businesses in which workers will be exempted from staying home, including those in health care, emergency services, food and agriculture, energy, water and sewage treatment, transportation, communications and information technology, hazardous materials, financial services, chemical, and defense-industrial sectors. Inslee said those sectors were chosen based largely on federal guidelines.”

On March 19th, Christopher Krebs from the U.S. Department of Homeland Security and Director of Cybersecurity and Infrastructure Security Agency (CISA) sent out a memorandum outlining essential critical infrastructure for the COVID-19 response. He began by quoting the President’s updated Coronavirus Guidance for America:

“If you work in a critical infrastructure industry, as defined by the Department of

Homeland Security, such as healthcare services and pharmaceutical and food supply, you

have a special responsibility to maintain your normal work schedule.”

Healthcare and public health staff are the first category prioritized in the communication, explicitly calling out both community mental health and call center workers.

How can we help?

Thanks to federal and state emergency declarations relaxing regulations on telehealth to halt the spread of COVID-19, outpatient behavioral health and crisis call centers are increasingly working virtually. (That said, it will take some time, and some workers may continue to need to go on site while practicing social distancing.) Mobile crisis and crisis facilities, by contrast, require face-to-face involvement, and they are a critical player to decrease community exposure for people in psychological distress, diverting them from emergency departments overburdened by the coronavirus. We know from experience that immediate access to help, hope, and healing saves lives while delays far too often contribute to justice system involvement, homelessness, and disability. During the COVID-19 pandemic, it also means potential exposure to a communicable disease. States across the country have been strengthening their crisis continuum, but they could not have foreseen how these principles would be catapulted in importance by COVID-19 and the surge in demand on hospital care in early 2020.

While there is no federal directive or standard, and this national outbreak is unique, at minimum, essential mental health crisis services should include:

  • Crisis call center hubs,
  • 24/7 mobile crisis teams,
  • and Crisis stabilization centers.

There are other behavioral health services, beyond the core crisis continuum, that may also constitute an essential community safety net. These might include the following:

  • Community mental health centers,
  • Methadone/OBOT clinics,
  • Residential behavioral health providers,
  • Psychiatric residential,
  • and 24/7 community resident services that serve children and youth, and people with developmental, intellectual, physical and/or cognitive disabilities.

Brian Hepburn, MD, executive director of the National Association of State Mental Health Program Directors (NASMHPD), told #CrisisTalk that crisis services play a vital role in reducing the burden on emergency departments. “This is the time to maximize the use of telehealth, provide support to people in their homes, and increase staff on all crisis service levels to meet the rise in demand.” He emphasized that staff at crisis programs need easy access to PPE and coronavirus testing with quick result turnaround. “We need to ensure that people on the front lines are adequately supported to stop the spread of contagion and fight the pandemic.”

Below, we’ve provided a sample letter for organizations to use. Please fit it to your organization and its specific services. We suggest that it’s printed on letterhead and signed by the CEO or director of the organization. Becky Stoll, vice president for crisis and disaster management at Centerstone, shared with us that she’s asked employees to keep a copy of the letter on hand, along with their driver’s license and work identification/employee badge, in case they are pulled over and need to illustrate that they are essential personnel.

At this time, nowhere in the United States has the kind of lockdown that would require such documentation, but this information can empower crisis staff who hear about recommended stay in place orders. And, other countries (Italy and China, for example) have already imposed more stringent quarantines and questioned people who were outside their homes. Hopefully, we won’t need such an approach, but as communities strip down to essential services, it may be good to have on hand.



March 26, 2020

To: Law Enforcement and Whomever It May Concern

Re: Identification of Essential and Critical Business, Infrastructure, and Services Personnel

This letter is to confirm that the person presenting this letter:

    • Is an employee working with [name of organization], which has operations throughout [location] and is authorized to provide essential and/or critical business, infrastructure, or services, and
    • Is authorized to commute to or from a work location to carry out essential business, support, or services.

[Name of organization] is an organization committed to the delivery of high-quality mental health and substance use services in multiple states throughout the nation, including 24/7 crisis care and intensive treatment programs viewed as essential services during this national emergency.

At a time when hospitals are at capacity to support people in respiratory distress, our crisis mobile and facility-based crisis services serve as indispensable resources to divert unnecessary visits to the hospital ER. It will mean the difference in thousands of lives.

Please see the March 19, 2020 memorandum from Christopher Krebs (director of the Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency (CISA)) outlining essential critical infrastructure for the COVID-19 response. Please let us know if you require additional support and/or documentation in your community and/or state to ensure the continuing operations of your critical care (my 24/7 contact information is below).

We respectfully ask that you please allow our team member to travel locally to support our efforts to deliver 24/7 care services to those in need during this time in which self isolation or stay at home orders are in place. Thank you!

Organization CEO or director’s signature


Direct phone number


What’s happening in your community during COVID-19? Let us know at