Mental health crisis response services are a vital part of any mental health service system. A well-designed crisis response system can provide backup to community providers, perform outreach by connecting first-time users to appropriate services and improve community relations by providing reassurance that the person’s needs are met in a mental health crisis.
What Makes an Effective Mental Health Crisis Service?
Mental health crisis services vary depending on where an individual lives. Becoming familiar with the available services and how to access them is an important step towards being prepared for a psychiatric crisis. The better prepared a person is when faced with a crisis situation the better the outcome. The following are pieces that together make up an effective response system.
- 24-Hour crisis lines are often the first point of contact for a person in crisis or their loved one. Telephone crisis services provide assessment, screening, triage, preliminary counseling, and information and referral services.
- Walk-in crisis services, such as clinics or psychiatric urgent care centers offer immediate attention. They focus on resolving the crisis in a less intensive setting than a hospital, though they may recommend hospitalization when appropriate. Walk-in clinics may serve as drop-off centers for law enforcement to reduce unnecessary arrests.
- Mobile crisis teams intervene wherever the crisis is occurring, often working closely with the police, crisis hotlines and hospital emergency personnel. Mobile teams may provide pre-screening assessments or act as gatekeepers for inpatient hospitalization and can also connect an individual with community based programs and other services.
Respite Care and Residential Services
Crisis respite and residential services can help a person stabilize, resolve problems and connect with possible sources of ongoing support. Services that may be provided include physical and psychiatric assessment, daily living skills training, social activities, counseling, treatment planning and connecting to services. Crisis residential services can either be an alternative to hospitalization or a step-down setting upon leaving a hospital.
Crisis respite services are also beneficial because they can provide short-term relief to individuals who are caring for family members who might need more support outside of the home.
There are various models for providing respite care depending on how much support is needed:
- Family-based crisis home support is where the person in crisis lives with a screened and trained “professional family.” In addition to practical and emotional support from “family” members, mental health professionals visit the home daily for planning treatment.
- Crisis respite centers and apartments provide 24-hour observation and support by crisis workers or trained volunteers until a person is stabilized and connected with other supports. In some locations, peer support specialists provide encouragement, support, assistance and role models in a non-threatening atmosphere.
- In-home support is like a crisis apartment but in the person’s own residence and may be used if separation from the everyday environment is not necessary.
Crisis Stabilization Units
Crisis Stabilization Units (CSU) are small inpatient facilities of less than 16 beds for people in a mental health crisis whose needs cannot be met safely in residential service settings. CSUs may be designed to admit on a voluntary or involuntary basis when the person needs a safe, secure environment that is less restrictive than a hospital. CSUs try to stabilize the person and get him or her back into the community quickly.
Extended Observation Units (23-Hour Beds)
23-hour beds, also known as extended observation units (EOUs) can be a stand-alone service or embedded within a CSU. Admission to an EOU is appropriate when the crisis can be resolved in less than 24 hours. EOUs are designed for persons who may need short, intensive treatment in a safe environment that is less restrictive than a hospital.
There may be times when a person is admitted to the hospital for intensive treatment. Private psychiatric hospitals, general hospitals with a psychiatric floor or state psychiatric hospitals are designed to be safe settings for intensive mental health treatment. This can involve observation, diagnosis, changing or adjusting medications, ECT treatments, stabilization, correcting a harmful living situation, etc.
If a person and their doctor agree that inpatient treatment is a good idea, they will be admitted on a voluntary basis, meaning that they choose to go. Some private hospitals will only take voluntary patients.
If a person is very ill and refuses to go to the hospital or accept treatment, involuntary hospitalization is an option. The legal standard for an involuntary hospitalization requires that a person be considered a “danger to self or others.” This type of hospitalization usually results in a short stay of up to 3 days but can occasionally last a week or so longer.
For an involuntary hospitalization to be extended, a court hearing needs to be convened, and a judge and two doctors must agree that there is still a need for hospitalization. The rules for involuntary hospitalization are done at the state level. The initial criteria are typically based on whether or not there is an immediate safety risk to his or herself or others. In other states, other criteria, such as being severely disabled, may be used as criteria for involuntary hospitalization.
Before a person is discharged from the hospital, it is important to develop a discharge plan with a social worker or case manager. Family members should be involved in discharge planning if the person is returning home or if they will need significant support. A good discharge plan ensures continuous, coordinated treatment and a smooth return to the community.
Partial Hospitalization or Day Hospitalization
Partial hospitalization provides care and monitoring for a person who may be having acute psychotic symptoms without being a danger to self or others. It allows a person to return home at night and is much less disruptive. It can also be used as a transition from inpatient hospital care before a complete return home.
When it isn't possible to get treatment from a mental health center or private doctor, or a situation escalates into an emergency and safety is a concern, a visit to an emergency room might be the only option.
Situations that might require a trip to the emergency room include:
- A suicide attempt
- Assault or threatening actions against another person
- Hearing voices, paranoia, confusion, etc
- Drugs or alcohol use
If you are calling 911, be sure to tell the operator that it is a “mental health emergency” and ask for emergency responders with Crisis Intervention Team (CIT) training. Many first responders will approach a mental health situation differently if they know what to expect.
A person can expect to be registered upon arriving at the emergency room. This will involve paperwork and answering questions about insurance, medical history, etc. Medical staff will then quickly make an assessment to determine how urgently care is needed. A psychiatric examination will establish a “working diagnosis” and determine a plan of action. Most people will receive tranquilizing medications, crisis counseling, an explanation of what’s happening and a referral for treatment after discharge.
Having a crisis plan that determines steps to take to prevent a crisis and to handle a crisis once it's developed can help prevent emergencies from escalating.