Expanding Mental Health Services Through Community-Based Care: Crisis Stabilization Centers

Micaela Enger                                                                                                                                                                      Associate Editor                                                                                                                                                                  Loyola University Chicago School of Law, JD 2023

Many believe that a hospital emergency department is potentially the worst place for an individual experiencing a mental health crisis. Emergency departments are often loud, bright, and bustling with hospital employees, emergency responders, patients, and visitors. These conditions are stressful and can further trigger additional symptoms for individuals facing a psychiatric crisis. Moreover, many individuals experiencing a mental health crisis do not require inpatient care at a psychiatric hospital. Rather, there is a growing trend to promote community-based care through Crisis Stabilization Center Models. Crisis stabilization centers or units provide an alternative to traditional emergency department and psychiatric hospitalization care by providing continuous care for a short period of time in a safe environment for those with an acute psychiatric crisis.

How are Crisis Stabilization Center Models different from the traditional care strategy?

Crisis stabilization centers provide urgent care for individuals facing mental illness, substance abuse disorders, behavioral health issues, or other psychiatric health crises. There are different models depending on the state or jurisdiction requirements for mental health facilities and how they interact with other healthcare services. In some models, patients can walk in on their own, while in others, patients must be referred by a provider or dropped off by a law enforcement officer or first responder. The types of services can vary between screening and assessments, counseling, prescribing, and monitoring medication, and connecting patients to other community-based services, such as providing housing resources. The amount of time patients can stay in a crisis stabilization center can also vary. Patients typically receive continuous interdisciplinary care for 23 or 24 hours; however, some models provide voluntary care for several days. Patients may still require further inpatient care; however, crisis stabilization models greatly reduce the number of patients that experience involuntary hospitalization.

What are the benefits of Crisis Stabilization Center Models?

As an alternative to emergency department and psychiatric hospital inpatient care, crisis stabilization centers or units reduce the frequency, cost, and length of stay in a hospital setting for patients experiencing mental health, behavioral, or general psychiatric crises. Crisis stabilization center models typically take an interdisciplinary approach to care as well. An interdisciplinary approach provides more comprehensive and integrated care by coordinating law enforcement, ambulatory services, emergency responders, hospitals, social workers, and many other providers and professionals that play a role in addressing psychiatric health. These models could also promote the reduction of healthcare spending as a recent study showed that a crisis stabilization center in rural Illinois saved approximately $4.1 million in Medicaid costs.

What are the barriers?

Crisis stabilization center models face many barriers and challenges. Insurance requirements often narrowly define prospective patients, which makes it difficult to deliver mental health services on a larger scale or in a rural community or smaller population. States must turn to different limited sources of funding instead of private insurance. Further, public payers, like Medicaid, are more accommodating to progressive delivery for mental health services, which might serve some communities well, while leaving others with less options. A community transition to crisis stabilization centers could also pose issues as the population is accustomed to bringing patients to an emergency department. Once a patient is in the emergency department special transportation to a crisis stabilization center must be arranged. Additional training for law enforcement and first responders would also be necessary to effectively triage patients and determine the correct placement for them.

Licensing issues are often the most complex regulatory hurdles to overcome. From emergency medical services (“EMS”) personnel to ambulance operations, and the facilities themselves, there are many compliance requirements that need to be amended to promote crisis stabilization models. In addition, the crisis stabilization center must acquire certain medical clearances, certifications to restrain or hold patients, and certifications for involuntary admissions. Many states require that ambulances can only take patients to an emergency department or for transport purposes. In addition, paramedics or emergency medical technicians might require additional licensing to evaluate a patient if they will not be seen by an emergency physician. Some models have considered using telemedicine to remedy provider licensing requirements. Moreover, many states do not have a license that accurately reflects the services that crisis stabilization centers propose to provide. These centers are not a hospital, and they are not an outpatient facility or necessarily an inpatient facility in many circumstances. Sometimes they provide emergency services, but some do not function as an emergency department. As a result, in terms of licensing, these centers are like a round peg being forced in a square hole. States may need to consider expanding scope of practice laws or creating novel licenses, specifically for mental health facilities of this type to address licensing issues while also amending laws that pertain to ambulance transportation.

Crisis stabilization centers offer important community-based services, but they might not work well in all states, counties, or communities. A successful crisis stabilization center bases its services on community needs. While there are only a handful of these centers throughout the country, they offer helpful case studies for how to successfully expand services for individuals facing psychiatric crises.