Bridging the Crisis Gap: A Scoping Review of Psychological Distress and Help-Seeking Behaviors in Black Americans Using Crisis Hotlines.

Black Americans often rely on 9-1-1 or emergency rooms rather than mental health hotlines, reflecting enduring mistrust in formal crisis response systems. This scoping review synthesizes evidence published between 2010 and 2025 on psychological distress and help-seeking behavior among Black Americans using crisis hotlines, with particular attention to engagement with the 988 Suicide & Crisis Lifeline. Six databases were systematically searched, yielding 1,536 records. Following screening and quality assessment using COVIDENCE and PRISMA-ScR guidelines, ten studies met the inclusion criteria for in-depth analysis. Drawing from these ten studies, six major findings emerged. First, hotline underutilization remains persistent, with Black callers consistently underrepresented even as national call volume increased by 283%. Second, calls involving Black individuals are disproportionately escalated to 911 for “active rescue,” with 53% leading to police involvement, far exceeding their 32% population share. Third, widespread mistrust of formal mental health systems drives reliance on informal supports such as family networks, churches, and schools. Fourth, workforce shortages and infrastructural gaps persist, with only 41% staffing readiness for 988 implementation in counties with large Black populations. Fifth, the absence of disaggregated and longitudinal data limits the assessment of equity and service outcomes. Sixth, racial differences in help-seeking patterns remain evident, as Black adults are significantly more likely to recommend calling 911 (χ² = 21.7, p < .01) or visiting an emergency room rather than using a crisis hotline. Overall, these findings reveal how structural inequities, cultural mistrust, and systemic barriers shape Black Americans’ engagement with crisis services during psychological distress. Limited access to culturally responsive care, inadequate infrastructure, and fear of punitive interventions perpetuate disparities in crisis response. The evidence underscores the urgent need for community-driven, culturally grounded, and equity-centered crisis systems that foster trust, safety, and representation for Black communities.