This fact sheet is one in a series outlining questions that local officials can ask and resources they can use to prioritize potential improvements to behavioral health emergency responses.
For people experiencing mental health- or substance use disorder-related crises, jails and emergency departments have become frequent landing places. But overusing these facilities in response to behavioral health emergencies can be problematic.
Emergency room visits for mental health, substance use, or similar needs increased by more than 44% from 2006 to 2014. Although emergency department staff members are equipped to triage and stabilize individuals with acute psychiatric and medical conditions, people who need psychiatric hospitalization can end up waiting in some emergency departments for days, weeks, and even months. Those delays add to emergency room overcrowding, which overwhelms an important resource for the entire community.
Meanwhile, county jails and other correctional facilities are ill-equipped to handle the treatment needs of people with behavioral health issues, and incarceration can exacerbate certain mental health disorders. Yet jails are often filled with people whose mental health needs could be better supported elsewhere. A study of Los Angeles County jails, for instance, determined that more than 60% of their population with mental illnesses likely could have been better served by community programs, as opposed to incarceration.
Unfortunately, finding appropriate care outside of jails and emergency departments for people with behavioral health needs is extremely difficult. In 2019, national survey data showed that 57% of people with a mental illness and 80% of those with a substance use disorder did not get needed care. And according to 2019 data, the most recent available, just 28% of mental health needs are met in federally designated Health Professional Shortage Areas (communities or neighborhoods with shortages of health care professionals) throughout the 50 states.
In theory, behavioral health crises offer opportunities to help people in two distinct ways: through short-term intensive care (known as stabilization), and by connecting patients to additional care to support their long-term health and avoid future crises. Some communities have managed to do this, implementing a multistep process that aims to reach, assess, and stabilize people at the scene of an emergency; transition them to the next step of care; and ultimately connect them to sustained treatment services in their area.
But many communities face a wide range of obstacles that can prevent them from systematically building care connections. Barriers include securing funding to sustain crisis response services, adequately staffing existing and envisioned crisis centers, and engaging public health and safety personnel in coordinating successful transitions from initial encounter to crisis services. These services can range from “bridge clinics,” which help transition patients from one level of care to the next, to in-home support services that offer short-term care in a comfortable environment.
Local leaders seeking to examine and improve crisis systems can ask themselves a series of critical questions:
After the immediate emergency, what behavioral health services are available and how are they used?
By assessing community services, local leaders can uncover gaps and identify challenges and priority areas for improvement.
- The National Association of State Mental Health Program Directors (NASMHPD) provides a helpful breakdown of varying types of crisis services.
- Many communities are building crisis stabilization centers to serve as alternatives to emergency departments and jails, increasing the chances that people will have their clinical needs met and will be connected to ongoing care. The Journal of Mental Health and Clinical Psychology describes these facilities.
- A national review of Certified Community Behavioral Health Clinics, conducted by Mathematica Policy Research for the U.S. Department of Health and Human Services, offers insights on existing local and state partnerships, as well as an example of a unique funding mechanism that enables flexible behavioral health services.
What government mechanisms exist to help sustain services and facilitate connections to care?
Existing local policies, interagency and public-private agreements, and other tools may serve as helpful foundations for communities to build on to improve and sustain funding for crisis services. Some communities have also established partnerships—with neighboring areas, state and federal agencies, private-sector actors, etc.—to make the most out of scant resources. But isolated policies can also create new barriers. For example, in rural communities where residents face challenges accessing mental health care—for reasons such as significant travel time or a dearth of clinicians—telehealth policies enacted to improve access can actually make it harder for those without reliable, affordable internet access to get help.
- The National Association of Counties (NACo) promotes health and safety by examining the behavioral health continuum of care and describes how counties are approaching pre- and post-crisis supports.
- NASMHPD offers strategies for delivering crisis services in rural and frontier counties.
- A 2018 study describes provider-payer partnerships wherein crisis centers collaborate with health plan providers to improve care, including examples of these partnerships and results that show individual improvements, as well as reductions in readmissions to crisis care, which suggest systemwide progress.
- National initiatives can assist local efforts. The Stepping Up initiative, for example, provides a range of materials for participating county policymakers on how to divert people in crisis from jail.
How do crisis service providers collect and analyze data, and how are data collection efforts between call centers and response teams updated to include post-crisis outcomes?
Over the course of a given behavioral health emergency, multiple agencies and service providers have the opportunity to collect valuable data. Understanding data collection and analysis protocols among local crisis services and determining how that data is shared with other agencies involved in an emergency (e.g., call centers, first responders) helps public officials determine information gaps from the initial report of a crisis to its outcome. Establishing that complete picture consistently for each emergency will allow local officials to identify trends that inform their approaches and improvements.
- The Substance Abuse and Mental Health Services Administration has a step-by-step guide on gathering data from local crisis intervention teams, which can help inform local officials’ practice.
- A systematic review of multiple studies underscores the importance of tracking individuals’ longer-term outcomes following behavioral health crises.
- The International Association of Chiefs of Police and the University of Cincinnati Center for Police Research and Policy reviewed outcomes of mobile crisis responses, providing a wealth of information that can help illustrate to local leaders the potential of robust data collection.
- NACo offers a variety of reports that showcase opportunities and ideas for data-sharing across health systems and criminal justice programs.
This publication is funded in part by The Pew Charitable Trusts with additional support from the John D. and Catherine T. MacArthur Foundation.