Behavioral Health Crisis Stabilization Centers: A New Normal

Abstract

Shifting resources and funding from institutionalized care for those with mental illness to community-based care has shown promise for behavioral health parity in health crisis circumstances and yet, it has been underfunded. One of the unfortunate trends of deinstitutionalization of behavioral health services in general has been a persistent gap in emergency crisis services. This gap in services leaves those in a behavioral health crisis to receive treatment in the Hospital Emergency Departments culminating in an astounding increase in overall healthcare expenditures. Providing behavioral health crisis assessment and treatment in busy emergency departments that produce long waits for care can be a challenging environment for those in need of immediate treatment for psychological needs. Crisis Stabilization Centers are effective at providing suicide prevention services, addressing behavioral health treatment, diverting individuals from entering a higher level of care and addressing the distress experienced by individuals in a behavioral health crisis. Studies also show that the cost of Crisis Stabilization Centers is significantly less than psychiatric inpatient units and satisfaction among clients is greater. Expanding the options for Behavioral Health Crisis Care from community-based behavioral health outpatient care and inpatient care to various community alternatives, benefits individuals in crisis as well as the community. This article provides an overview of community alternatives to psychiatric hospitalization, financial barriers to care and future research.

Suicidal Presentations to Emergency Departments in a Large Australian Public Health Service over 10 Years

“…The importance of timely access to data is particularly evident in times of anticipated changes in suicide risk experienced by broader communities, as seen with the spread of COVID-19 [ 58 ]. The fact that over the last 10 years, the increase in suicidal presentations has by far exceeded the increase seen for all ED presentations also highlights the need for consideration of alternative models of care to avoid the overwhelming of health systems [ 59 ].…”

Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study

“…Regarding organizational issues, staff members underlined communication problems between staff and organizations, often related to their distinct cultures, values and practices as observed in other studies [ 25 , 27 , 28 ]. While recovery is now central to MH treatment, the lack of appreciation for peer expertise among health professionals reported in our study is frequently mentioned in the literature [ 19 , 20 ], as is the problem of staff turnover [ 52 – 54 ] and insufficient involvement in innovations [ 23 ], all important barriers to implementation also identified in this study.…”

“…Studies have investigated the implementation of MH innovations in ED [16,[21][22][23]], yet the evidence on their results and efficacy is mixed [15,24,25]. Thus, further research is needed.…”

“…Concerning implementation, studies on MH innovations have investigated system-level, organizational and individual (staff, patient, family) factors [ 23 ]. Factors hindering implementation at the system level due to lack of funding, access, continuity or required intensity of services were common to the three ED intervention types [ 21 , 22 , 25 ], whereas organizational-level barriers related more to problems with inter-professional collaboration and communication [ 24 , 26 ]. A lack of ongoing quality assessment [ 21 ] and structured referral processes [ 15 ] were key implementation factors reported in brief intervention services.…”

“…Concerning the impact of ED innovations, reduction in costs [ 25 , 31 , 32 ], ED wait times [ 33 – 35 ], ED use [ 6 , 15 , 35 ] and hospitalization rates [ 16 , 18 , 36 ] were most often cited, regardless of intervention type, while the adequacy of referrals generally improved [ 27 , 37 , 38 ] in brief intervention and peer-user support services. In terms of health outcomes, patient symptoms decreased for the three intervention types [ 25 , 26 , 36 ]. Although few studies have investigated patient satisfaction [ 23 , 39 , 40 ] or quality of life [ 19 ], results tend to be positive.…”