Cooperative Agreements for States and Territories to Improve Local 988 Capacity - The Missouri Department of Mental Health (DMH), referred to throughout this application as Grantee, will strengthen Missouri's statewide 988 system through expanded partnerships, workforce development, quality improvement, and integration across the crisis continuum. Building upon statewide 988, Mobile Crisis Response (MCR), and Behavioral Health Crisis Centers (BHCCs), this cooperative agreement will improve timely access to high-quality crisis services for individuals at risk of suicide and overdose while strengthening continuity of care. Since implementation of 988 in July 2022, Missouri has built a coordinated crisis response system that continues to improve timely access to crisis intervention and crisis services for all Missourians, particularly individuals at risk of suicide and overdose. Grantee oversees a statewide 988 system consisting of six 988 call centers and one statewide text and chat center. Missouri also maintains statewide 24/7 MCR services and a network of 26 BHCCs, creating a coordinated crisis continuum that promotes timely access to care and diverts individuals from emergency departments and the criminal justice system when appropriate. Through this cooperative agreement, Grantee will continue strengthening integration across the crisis continuum by supporting onboarding of additional 988 Centers operated by Certified Community Behavioral Health Clinics (CCBHCs). These providers will deliver both crisis services and the full array of CCBHC services, further strengthening continuity of care by connecting individuals to ongoing behavioral health care. Since implementation, Missouri has witnessed a steady increase in demand for 988 services. From July 2022 through June 2025, Missouri's 988 Centers received 230,021 calls, 64,221 texts, and 37,145 chats. During that period, call volume increased by 96%, while text and chat volume increased by 120% and 127%, respectively, following implementation of statewide text and chat routing in September of 2022. As demand continues to grow, Grantee will continue assessing funding needs, workforce capacity, and system improvements necessary to maintain a 90% or higher in-state answer rate while strengthening response across all 988 modalities. Building upon accomplishments achieved through the previous 988 State and Territory Capacity Cooperative Agreement and continued state investment, this cooperative agreement will support statewide evaluation, quality improvement, workforce development, strategic partnerships, and public awareness efforts that further strengthen Missouri’s crisis response system. Key objectives include onboarding additional CCBHC-operated 988 Centers, strengthening statewide quality monitoring and follow-up practices, expanding public awareness of 988, and enhancing workforce capacity, workforce wellbeing, and long-term sustainability. Upon completion of the cooperative agreement, Grantee will have achieved the following goals: 1. Strengthen coordination and integration across Missouri’s crisis response system to improve access to community-based services and continuity of care. 2. Improve the quality and consistency of Missouri’s 988 services through statewide evaluation and quality monitoring. 3. Increase awareness, understanding, and utilization of 988 and Missouri’s crisis response system through statewide messaging and education. 4. Strengthen workforce capacity and long-term sustainability of Missouri’s 988 system. Through this cooperative agreement, Grantee, in partnership with 988 Centers, crisis providers, and community partners, will continue building an integrated, sustainable, and data-informed crisis response system that expands access to high-quality crisis services, strengthens continuity of care, and advances the Substance Abuse and Mental Health Administration’s (SAMHSA) vision of serving anyone, anywhere, at any time.
