Community-Based Crisis Services, Specialized Crisis Facilities, and Partnerships With Law Enforcement

Abstract

How a community responds to behavioral health emergencies is both a public health issue and a social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments, boarding for hours or days while awaiting treatment. Such crises also account for a quarter of police shootings and 2 million jail bookings per year, and racism and implicit bias magnify these problems for people of color. Fortunately, the new 988 mental health emergency number compounded with police reform movements have created momentum for building behavioral health crisis response systems that deliver comparable quality and consistency of care as we expect for medical emergencies. This paper provides an overview of the rapidly evolving landscape of crisis services. The authors discuss the role of law enforcement and various approaches to lessening the impact on individuals experiencing behavioral health emergencies, especially for historically marginalized populations. The authors provide an overview of the crisis continuum, including crisis hotlines, mobile teams, observation units, crisis residential programs, and peer wraparound services that can help ensure that linkage to aftercare is successful. The authors also highlight opportunities for psychiatric leadership, advocacy, and strategies for creating a well-coordinated crisis system that meets the needs of the community.

Keywords: Crisis intervention; Emergency Psychiatry.

FIGURE 1.

The sequential intercept model^{a a}Intercepts 0 and 1 focus on programs that minimize law enforcement interactions and prevent the arrest of people experiencing behavioral health emergencies by instead connecting them to the treatment they need.

FIGURE 2.

The crisis continuum^{a a}In a high-functioning crisis system, the individual services in the continuum work together to achieve a common goal; in this case, stabilization in the least restrictive (which is also the least costly) level of care. Data were provided by Arizona Complete Health/Centene, and they apply to the southern Arizona geographical service area for 2019 (Cochise, Graham, Greenlee, La Paz, Pima, Pinal, Santa Cruz, and Yuma counties). “Crisis line resolved calls” pertains to the percentage of calls resolved without dispatching mobile crisis, law enforcement, or emergency medical services. “Mobile crisis resolved cases” refers to the percentage of face-to-face encounters resolved without the need for transport to a higher level of care. “Crisis facilities community disposition” refers to the percentage of discharges to levels of care other than a hospital, an emergency department, or jail. “Continued stabilization” refers to the percentage of individuals with a mobile crisis or crisis facility encounter who did not have a subsequent emergency department visit or hospitalization within 45 days.