The Power of Crisis to Transform Behavioral Health: A Reflection on Change and Champions

By Dr. John Draper

In the behavioral health landscape, the push for system change has been a long, uphill journey. Many crises—natural disasters, tragic shootings, economic downturns, and pandemics—have catalyzed shifts in our field, spotlighting where our systems fall short and how innovation and leadership can reshape our response.

Looking back at events like the hurricanes that battered the Southeast in 2004 and Hurricane Katrina in 2005, these crises revealed the need for a comprehensive mental health response. During these trying times, behavioral health and crisis response systems have often become the steady, guiding force—a form of “air traffic control” that helps people find the resources to rebuild their lives emotionally, even after their immediate physical needs have been met. These challenges underscore a plain truth in our field: crisis doesn’t just expose gaps; it also creates opportunities to innovate.

We’ve seen how these moments of upheaval lead to seismic changes. For example, the influx of evacuees from the Gulf Coast after the 2005 hurricanes directly inspired Georgia to create the Georgia Crisis and Access Line (GCAL), the first statewide crisis care system in the U.S. GCAL became a model for other states, demonstrating the profound impact a coordinated, crisis-centric approach can have on the broader behavioral health system. Colorado similarly established its own statewide crisis system in response to a tragic shooting in Aurora, a testament to how crises can prompt statewide shifts in mental health policy and care.

Leadership and a Vision for Change

However, these changes are not merely products of crisis. They result from champions—individuals within the system who have committed themselves to advocating for meaningful reform. Leaders like Mike Hogan, former Ohio State Mental Health Commissioner and key figure in the President’s New Freedom Commission on Mental Health, have long championed nontraditional approaches that disrupt the status quo. The 2003 New Freedom Commission’s report concluded that traditional reform would not suffice; it called for a fundamental transformation in how mental health care is delivered. Hogan’s leadership extended beyond state boundaries, setting the foundation for many reforms that continue to evolve today.

It takes vision and, frankly, a certain level of endurance to work against decades of inertia in behavioral health. Since the 2004 inception of the National Suicide Prevention Lifeline (now under Vibrant), partnerships with organizations like the National Association of State Mental Health Program Directors (NASMHPD) have been critical in moving forward. In 2007, a presentation at NASMHPD’s annual meeting showcased the Georgia Crisis and Access Line (GCAL) model, and state leaders began to take notice, even as the Great Recession of 2008 slashed budgets. Through relentless dedication, commissioners like Arizona’s Tom Betlach found ways to leverage federal Medicaid funding to support crisis programs, showcasing how braiding multiple funding sources could provide a stable backbone for innovative crisis response.

Paradigm Shifts Driven by Outsiders

The call for change has often come from the field’s “outsiders”—voices that challenge existing norms and catalyze a paradigm shift. Historian and philosopher Thomas Kuhn introduced this concept in the 1960s, describing how breakthroughs in science disrupt accepted paradigms, creating space for new approaches. Behavioral health is undergoing such a transformation now, driven by leaders unafraid to challenge outdated practices and embrace new technologies and care models.

For instance, the widespread adoption of telehealth during the pandemic redefined what access to mental health services could look like, expanding care into homes across the nation. Rising suicide rates over recent decades spurred Congress to implement 988, a new three-digit number that will enhance access to crisis and suicide prevention services nationwide. When crises highlight systemic weaknesses, leaders like Hogan, Betlach, and many others seize the moment to turn these disruptions into lasting advancements in care.

The Path Forward: Building Resilient Systems

For behavioral health, the lesson is clear: the first step in transforming a system that’s been “broken” for so long may well begin with establishing robust crisis response capabilities. Crisis care represents the critical bridge between immediate intervention and long-term mental health support, helping to bring people back to safety while also setting them on a path toward healing and stability. Our system’s evolution shows that when we take crisis services seriously—funding them, embedding them in policy, and staffing them with compassionate professionals—we’re not just responding to emergencies; we’re fortifying our entire approach to mental health care.

This journey hasn’t been solitary. Many champions—Mike Hogan, Brian Hepburn, Gwen Skinner, and other dedicated commissioners—have paved the way. They’ve proven that even within constrained budgets and complicated bureaucratic landscapes, innovative, nontraditional approaches are possible and can be transformative.

As we continue to move forward, we must remember the fundamental truth underscored by years of change: every person, every story, and every crisis matters. Embracing this philosophy, we can build a future where crisis care serves not only as a lifeline in emergencies but also as a catalyst for systemic change in behavioral health. And we owe immense gratitude to those champions who, undeterred by challenges, have paved this road toward a more resilient, responsive, and humane mental health care system.