Crisis mental health care in the United States is inconsistent and inadequate. This is tragic in that good crisis care is a known effective strategy for suicide prevention, a preferred strategy for the person in distress, a key element to reduce psychiatric hospital bed overuse, and crucial to reducing the fragmentation of mental health care.
Short-term, inadequate crisis care is shortsighted. Imagine establishing emergency services in a town by purchasing a 40-year-old fire engine and turning the town’s old service shop into the fire station. It will work until there is a crisis.
With non-existent or inadequate crisis care, costs go up because of hospital readmissions, overuse of law enforcement, and human tragedies. In too many communities, the “crisis system” has been unofficially handed over to law enforcement, sometimes with devastating outcomes. Our current approach to crisis care is patchwork, delivering minimal care for some people while others (often those who have not been engaged in care) fall through the cracksresulting in multiple readmissions, life in the criminal justice system, or death by suicide.
Our country’s approach to crisis mental health care must be transformed. Crisis care is the most basic element of mental health care, yet in many states and communities, it is taken for granted. Limited. An afterthought. A work-around. Even non-existent. In many communities, the current crisis services model depends primarily upon after-hours work by on-call therapists or space set aside in a crowded emergency department (ED). These limited and fragmented approaches are akin to plugging a hole in a dike with a finger.