Crisis health care in the United States is built on the premise that a person needs either outpatient or inpatient treatment. The system is not nuanced, even though the needs of individuals with behavioral health issues may be incredibly so. David Covington, LPC, MBA, Chief Executive Officer and President at RI International, likens it to giving everyone the same sized shoe—if all that is available is Level 6 acute care, then that is what people will receive.
The result is that people often end up in an Emergency Department’s (ED’s) stream of care, which is problematic as patients can be stuck in the ED for long periods of time without receiving appropriate psychiatric care. In fact, researchers at Wake Forest University found that people with psychiatric emergencies spend more than three times longer in the ED than those with physical illness and injuries. It is not in the patient’s best interest and is costly, resulting in a cost of $2,264 per psychiatric patient.
The Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) stated in a May 2015 Statistical Brief that hospital readmission within 30 days of discharge typically represents a negative clinical outcome for patients with mental disorders. The brief goes on to point out that this may be due to a variety of factors, including a person’s lack of access to adequate community-based aftercare, challenges to medication adherence, and self-care. The same brief stated that between 2003 and 2011, mental health hospitalization increased at a faster rate than any other type of hospitalization.
In response, behavioral health programs across the nation are fervently working to improve mental health crisis services as part of the care continuum they provide consumers. A retrospective quasi-experimental design in Australia found that consumers who used mobile community-based services were three times less likely to be admitted to a psychiatric inpatient unit than those who used hospital-based emergency services, regardless of their clinical characteristics. The Substance Abuse and Mental Health Services Administration (SAMHSA) states in its report Crisis Services: Effectiveness, Cost-Effectiveness, and Funding Strategies that crisis services can indeed decrease avoidable hospitalizations.