“Crisis Response”: An Alternative

09/30/2014

Archived 02/02/2017

As LaVerne Miller’s son turned 18, he started having symptoms of bipolar disorder. Now 26 years old, he has had a crisis bad enough to require hospitalization every year since he was first diagnosed.

Each time a crisis happens, Ms. Miller worries her son will wind up dead. That’s because she’s all too aware of incidents where families have called 911 to help with a family member in crisis, only to have the police harm or even kill someone they see as disturbed and dangerous.

What’s worse, Ms. Miller’s son’s hospitalizations were more harmful than helpful. During his last stay, for example, he was tackled by several attendants and involuntarily drugged. “The inpatient units have done more harm than good and have traumatized both him and our family for months,” Ms. Miller told participants in the first of a series of SAMHSA-sponsored webinars on crisis response.

In a recent blog, Paolo del Vecchio, Director of SAMHSA’s Center for Mental Health Services, said, “A behavioral health crisis is not the inevitable consequence of mental illness. But when one does occur, many factors can contribute, including lack of access to essential services and supports, poverty, unstable housing, coexisting mental illness and substance use disorders, other health problems, discrimination, and victimization.”

The blog also links to the full webinar series, “Expanding Behavioral Health Community-Based Crisis Response Systems,” that explores less drastic alternatives to the kind of crisis response services that have traumatized Ms. Miller’s son. Those alternative approaches are also less costly, according to a new SAMHSA report called Crisis Services: Effectiveness, Cost-Effectiveness, and Funding Strategies.

New Approaches

According to the new report, 5.3 million emergency room visits and 2.2 million hospitalizations in 2010 involved a mental health condition.

Traditionally, people having a psychiatric emergency seek help in hospitals. But as Ms. Miller’s story shows, hospitalization can be inadequate. Emergency rooms may lack the time and staff with specialized training needed to address patients’ needs. Plus, hospitalization is expensive.

Fortunately, there’s an alternative. Called “crisis services,” these are designed to stabilize individuals in psychological distress and engage them in the most appropriate course of treatment. In contrast to inpatient-based care, these services are designed to reach people in their own communities. The continuum of services includes telephone hotlines, peer crisis services, crisis intervention teams, mobile crisis services, crisis stabilization beds, short-term residential services, and more.

The evidence that crisis services work is growing. The research shows, for example, that short-term residential stabilization services, which use 24-hour observation and supervision to prevent or resolve crises, are as effective at improving symptoms as longer psychiatric inpatient care. Plus, patients report strong satisfaction with these services.

What’s more, crisis services are cost-effective. According to the new SAMHSA report, several studies demonstrate that crisis services can result in significant cost savings. Reduced use of inpatient services, diversion from emergency departments, and more appropriate use of community-based behavioral health services all help to lower costs.

Consider the research on having mobile crisis units respond to people in crisis rather than routine police intervention. In one study, mobile crisis intervention services reduced the costs associated with inpatient hospitalization by about 79 percent in the six months after a crisis.

Learn More

Now archived, SAMHSA’s webinar series focuses on how to expand community-based crisis response services and systems. The series describes new and emerging practices across the crisis response continuum, from pre-crisis planning to early intervention and crisis stabilization to post-crisis support. Using state and local examples, the series also discusses how such approaches are financed.

Webinar topics include:

The need for crisis response systems.
The continuum of community-based mental health crisis response approaches.
Outcomes and financing of crisis response services and supports.
Innovative state and local crisis response systems.

For LaVerne Miller, the growing availability of crisis services is a reason for hope for her son’s future. “Those things would have made a lot of difference in helping him,” she said.