Beyond the Emergency Department: Behavioral Health Urgent Care as a Child and Adolescent Mental Health Crisis Care Solution.

The Crisis Stabilization Unit.

How to Build a Pediatric Behavioral Health Crisis Intervention Program.

College students are vulnerable to depressive symptoms, suicidal ideation, sleep disturbance, and stress-related psychological problems. Aerobic exercise and repetitive transcranial magnetic stimulation (rTMS) have each shown therapeutic potential in affective disorders, but evidence on their combined application in college students at suicide risk remains limited, particularly when neurophysiological outcomes are considered. To evaluate the feasibility, safety, and preliminary effects of aerobic exercise combined with rTMS on suicidal ideation, depressive symptoms, sleep, and prefrontal functional activation in college students at suicide risk. This prospective single-centre non-randomised controlled pilot study will enrol students aged 18-21years who are identified as being at suicide risk by the Xinhai University Crisis Intervention System. At-risk participants will enter one of three groups: active rTMS plus aerobic exercise, sham rTMS plus aerobic exercise, or standardised group psychological intervention/usual support. A separately recruited healthy reference cohort will complete the same assessment schedule without active treatment. Active rTMS will be delivered over the left dorsolateral prefrontal cortex at 10Hz and 120% of the individual motor threshold once daily for 2weeks. Aerobic exercise will be prescribed at a target heart-rate zone of 135-164 beats/min for 30-60min per session every 2days for 2weeks, with heart rate and adherence objectively monitored. The primary outcomes are changes in the Self-rating Idea of Suicide Scale (SIOSS) total score and Self-rating Depression Scale (SDS) standard score from baseline to week 4. Secondary outcomes include SIOSS and SDS dimensions, total sleep time, task-related and resting-state functional near-infrared spectroscopy (fNIRS) measures, adherence, concomitant care, and adverse events. The study was approved by the Ethical Review Committee of Yancheng First People's Hospital (Approval No. 2023-K-230) and the Ethics Committee of INTI International University (Approval No. INTI-IU/FHLS-RC/BTCMI/AUGUST2022/003). Findings will be disseminated through peer-reviewed publications and academic conferences. Chinese Clinical Trial Registry, ChiCTR2400079723.

School-Based Mental Health and Crisis Care for Students.

The intersection between mental health and public safety within the United States constitutes an urgent yet woefully neglected field of social policy. A legacy of decades of deinstitutionalization, inadequate investment in community mental health capacity, and the structural role of law enforcement as first responders to crises of mental distress has yielded a costly, unjust, and clinically inadequate system. This literature review will address policies guiding the integration of mental health services into public safety systems in the United States, relying on peer-reviewed literature, government policy reports, and program evaluations. The review will chronicle the history of this policy space from the era of deinstitutionalization to subsequent legislative milestones at the federal level, evaluate the effectiveness of traditional law enforcement-based solutions, including Crisis Intervention Training, and analyze newer alternatives, including civilian mobile crisis teams, co-responder models, and telehealth-enhanced dispatch. Results suggest that alternative crisis response strategies, especially civilian-based solutions, show significant gains in terms of diversion, efficiency, and participant outcomes compared to those rooted in law enforcement. Nevertheless, systemic challenges impede efforts to scale and sustain these reforms. Sustained change requires federal, state, and local policy coordination, adequate behavioral health capacity and workforce development, and equity-focused program design.

Lesbian, gay, bisexual, transgender, two spirit, queer or questioning, intersex, and asexual (LGBTQIA+) individuals experience disproportionately high rates of suicidal ideation, attempts, and deaths compared to the general population. These disparities are fueled by systemic inequities, discrimination, and minority stress. Gatekeeper trainings such as Question, Persuade, Refer and SafeTALK have been shown to improve knowledge, skills, and self-efficacy in suicide prevention. Despite ongoing advancements in suicide prevention efforts, a significant need remains for approaches that move beyond general adaptation toward full integration of LGBTQIA+-specific factors. This gap leaves gatekeepers underprepared to recognize LGBTQIA+-specific risk factors and provide affirming support. To address this gap, we introduce BELONG, a conceptual framework for an LGBTQIA+-inclusive suicide prevention gatekeeper training. BELONG integrates minority stress theory, sociopolitical development theory, and intersectionality into the four established domains of gatekeeper training knowledge, attitudes, skill development, and self-efficacy. BELONG incorporates practical strategies such as LGBTQIA+-specific role-plays, affirming communication practice, tailored referral resources, and advocacy tools. These components are designed to strengthen gatekeepers' intervention confidence while expanding their capacity to address systemic barriers that exacerbate suicide risk. A distinguishing feature of BELONG is the positioning of advocacy as a cross-cutting construct. Rather than focusing exclusively on individual-level crisis intervention, the model emphasizes the role of gatekeepers in fostering affirming environments and promoting structural change. By embedding affirmation, belonging, and critical consciousness into a structured training framework, BELONG advances the field of suicide prevention through a culturally grounded model tailored to LGBTQIA+ populations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Civilian-led crisis response teams provide emergency mental healthcare for individuals in acute distress in community settings, often without the involvement of police as first responders. These models represent one of several emerging alternatives to police-led crisis response and have gained attention for their potential to improve safety, trust, and care outcomes. Reports included in this scoping review discussed: the development, need, potential, implementation, and outcomes of civilian-led crisis response models. Covidence software was utilized by two independent reviewers to search 11 databases, with a third reviewer resolving conflicts. A dataset of 46 reports were then analyzed with thematic content analysis by a multidisciplinary team using critical theories to offer an exploration of how civilian-led crisis teams have begun to address the harms of policing responses to mental health. In exploring the key processes for civilian-led crisis response teams, three themes emerged. The first theme, Decentering Police, explores the growing collective awareness of the harms associated with police-involved crisis intervention and the corresponding need for alternative approaches, alongside efforts to establish a team composition that is intentionally distinct. The second theme, Team Scope of Practice, explores the subthemes of dispatch logistics and defining criteria for response. Team Sustainability is the third theme and explores how social and political will shape the uptake and long-term operation of civilian-led crisis programs.

Suicidal ambivalence, the co-occurring desire to live and die is widely discussed in clinical practice yet remains understudied in empirical research. This qualitative study explored how young adult suicide attempt survivors understand and experience suicidal ambivalence. Using a phenomenological approach, in-depth semi-structured interviews were conducted with 19 young adult suicide attempt survivors between the ages of 18 and 29. Data were analyzed using thematic analysis. Five themes emerged across two areas. First, participants described suicidal ambivalence as a (1) internal conflict (2) a dynamic process, and (3) a source of comfort. Second, their experiences were characterized by (4) conflicting desires between life and death and (5) feelings of numbness. Suicidal ambivalence was seen as a dynamic psychological process that holds the tension between life and death. Future research should investigate how suicidal ambivalence can serve as a protective factor to serve as a potential entry point for crisis intervention.

Shelter and settlement are critical determinants of health in humanitarian crises, yet their impacts on health outcomes remain underexplored. This review synthesizes published evidence on how shelter and settlement interventions impact health outcomes in humanitarian crises. A systematic review of peer-reviewed literature was conducted to identify studies examining the association between shelter and settlement interventions and health outcomes in humanitarian crises. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines a protocol was developed and three databases were searched for studies published between 2005 and 2025. Relevant data were extracted and thematically analysed. A total of 138 articles were found. Thematic analysis identified six themes (living conditions, accommodation type, camp and site planning, displacement status, essential household items and cash-based interventions). Three cross cutting themes of gender, climate change and vulnerability were also identified. Two themes (living conditions and accommodation type) are presented here. Poor living conditions including damaged shelters, poor housing design and materials were associated with increased risks of communicable diseases such as malaria, diarrhoea, and soil-transmitted helminth infections while overcrowding heightened injury risk and psychological distress. Accommodation type influenced health outcomes with short-term shelters linked to acute mental health challenges and increased injuries; medium-term shelters with increased risk of non-communicable disease; and long-term housing with deteriorations in chronic disease management. This systematic review synthesises the evidence base showing how shelter and settlement interventions play a role in influencing health outcomes in humanitarian crises. It shows that shelter is a critical yet often under recognised determinant of health in these settings. Health outcomes are influenced by housing quality, accommodation type and duration, camp and settlement planning, displacement dynamics including frequency and length of displacement, and access to essential household items. Poor shelter conditions are likely to increase the risk of communicable diseases and mental health issues and have the potential to worsen chronic disease outcomes and risk. A key contribution of this review is the identification of shelter as a core entry point for public health action, highlighting the need for clearer operational guidance on shelter typologies, minimum standards, and their integration with health, protection and social services.

The Crisis Intervention Ward relocated from a general hospital to a psychiatric hospital in Basel, Switzerland, on May 26, 2023. We hypothesize that this relocation influenced patient demographics, frequencies of main diagnoses, involuntary admissions, transfer rates, clinical outcomes, patient satisfaction, and clinician perceptions of the treatment setting. We compared two patient cohorts: one from a 12 month period pre-relocation and the other from a 12 month period post-relocation. Two outpatient clinician surveys-one conducted pre- and one post-relocation-assessed location ratings, treatment satisfaction, and the perceived benefits and disadvantages of each location. Prior to relocation, 625 cases were treated; after relocation, 686 cases. Patient's age and gender showed no differences. The frequency of affective disorders (F3) was lower (Φ = - 0.124) at the psychiatric hospital. Clinical outcomes, involuntary patient admissions, and transfer rates to other psychiatric wards were comparable. Patient-reported satisfaction was lower at the psychiatric hospital (mean 4.6 vs. mean 5.2, r = 0.23). Outpatient clinicians favored the general hospital setting strongly (r = 0.78-0.81). Clinical outcomes remained stable, but patient satisfaction was lower after relocation, and clinicians perceived barriers related to accessibility and stigma at the psychiatric hospital.

This study evaluated four Mobile Response Teams (MRTs), providing 24/7 behavioral health crisis intervention services, using retrospective administrative records of calls made to an MRT hotline between May 1, 2024, and April 30, 2025. The sample included 2,300 eligible calls representing 1,960 unique individuals (Mage = 30.01 years, SD = 19.92, Range = 5-89). Programmatic descriptives examined call and final dispositions, method of response, and response times, while chi-square tests assessed bivariate associations and binary logistic regression assessed predictors of final disposition, dichotomized as psychiatric hospitalization vs. diversion. Across the 12-month observational period, 64.8% of cases resulted in diversion, and the average in-person response time was within the State of Florida's 60-minute benchmark. Consistent with the program's "in-person first" model, 95.0% of calls were addressed face-to-face. Significant independent predictors of psychiatric hospitalization included age (adults 18 + years), higher suicide risk scores, presence of a specific suicide plan, law enforcement involvement, call source (school setting), and call reason (suicide attempt/ideation). Findings from this large, ethnically diverse, naturalistic sample demonstrate that MRTs not only divert a substantial proportion of crisis cases from hospitalization but also consistently meet state standards for timely and "in-person first" response, with implications for behavioral health policy and crisis service delivery.

Homicide-suicide (H-S) is a rare but highly consequential form of fatal violence in which one or more homicides are followed by the perpetrator's suicide. Although H-S has been reported in several countries, systematic forensic data from the Czech Republic remain limited. This retrospective autopsy-based study analyzed H-S cases recorded in three regions of the eastern Czech Republic between 1998 and 2023 to characterize their epidemiological, medicolegal, and toxicological features. Variables were extracted from autopsy reports, police findings, and toxicological reports. Cases were classified according to the typology proposed by Marzuk etal. A total of 39 H-S incidents involving 108 decedents were identified, corresponding to a mean annual incidence of 0.06 incidents per 100,000 inhabitants. Intimate partner H-S was the most frequent subtype (46.2%), followed by familial (33.3%) and extrafamilial (20.5%) incidents. Perpetrators were predominantly male (92.3%); female perpetrators were younger and occurred exclusively in filicide-suicide cases. Firearms were the leading lethal mechanism, and method concordance between homicide and suicide was observed in 61.5% of incidents. Ethanol was detected in 11 of 39 perpetrators (28.2%) and in 9 of 69 victims (13.0%). Jealousy or revenge was the most commonly recorded motive in intimate partner and extrafamilial incidents, whereas altruistic motives were more prominent in familial cases. These findings are consistent with international patterns and indicate that H-S prevention requires multidisciplinary strategies focused on domestic violence escalation, mental health crisis intervention, firearm access assessment, and substance use as a contextual factor rather than a demonstrated causal factor.

Domestic violence and abuse (DVA) remains a major public health and human rights concern, with profound consequences for women's physical, psychological, and socioeconomic well-being. We report the case of a 32-year-old married woman and mother of two who experienced prolonged domestic violence, including physical, emotional, and economic abuse, compounded by her husband's alcohol dependence. Economic abuse escalated when debt incurred through a self-help group loan, intended to support the family's livelihood, was transferred to the survivor, reinforcing financial dependency and coercive control. Following a severe episode of physical violence that resulted in her displacement from the marital home, she sought support through a hospital-based crisis center established within a tertiary care women's hospital. Through crisis intervention, structured counseling, legal guidance, child welfare support, and employment assistance, the survivor achieved financial independence, secured safe accommodation, and initiated steps toward legal separation. This case highlights the often-overlooked role of economic abuse and debt bondage as mechanisms of control within abusive relationships. It also demonstrates the value of integrated, hospital-based crisis services and intersectoral collaboration in supporting survivors of violence. Strengthening routine identification of DVA within healthcare settings, expanding access to crisis centers, and promoting women's economic empowerment may contribute to improved safety and long-term recovery for survivors.

Receipt of violence (victimisation) is associated with a higher risk of severe mental illness and with worse illness severity; however, associations with routine clinical outcomes are less clear. To investigate associations between victimisation and subsequent clinical outcomes in people presenting with severe mental illness, using a south London health records data resource. Data were extracted for 16 372 patients presenting between January 2007 and October 2022, aged 18+ years and receiving diagnoses of schizophrenia-related disorders, mania or bipolar disorder. Recorded victimisation and subtype (any, physical, domestic or sexual) were ascertained via natural language processing from the first 3 months of the record following presentation. Cox regression models were deployed to investigate subsequent risk of mental health emergency care assessment, crisis intervention, in-patient care, Mental Health Act (MHA) detention and mortality. Poisson regression models investigated the numbers of attended healthcare events and antipsychotic agents received. Covariates included sociodemographic characteristics and clinical status (service receipt, medication, symptom profile). All victimisation exposures were associated with a higher risk of all outcomes, apart from mortality and number of antipsychotics, following adjustment for sociodemographic factors, and with emergency assessment (hazard ratio for any victimisation 1.17, 95% CI 1.09-1.27), in-patient/MHA detention (hazard ratio 1.32, 95% CI 1.06-1.65/1.82, 95% CI 1.31-2.55) and higher numbers of attended events (incidence rate ratio 1.17, 95% CI 1.16-1.19) following full adjustment. Associations were similar for subtypes of victimisation and exposures, and between men and women following sociodemographic adjustment, but the associations were slightly weaker for women following full adjustment. Experiences of violence, to the extent to which patients report their experiences and these are recorded, are risk factors for worse outcomes in severe mental illness, only partly accounted for by clinical status around the time of presentation. More systematic ascertainment and recording of victimisation needs to be considered if interventions are to be appropriately targeted.

The effectiveness of public health policies has a major impact on society. Throughout the COVID-19 pandemic, policy-makers worldwide introduced various public health measures, such as social distancing and mask-wearing, to address the severe threat posed by the disease. Despite the importance of these issues, there has been no direct, visual evidence that mask-related policies led to the appropriate mask-wearing behaviour of the general public. Here, we show that regulations and public transport announcements encouraged correct mask-wearing behaviour during the COVID-19 pandemic. Importantly, changes in announcement and regulation contents led to heterogeneous effects on behaviour. Our study contributes the first visual open-source empirical analysis of reactive human behaviour during the COVID-19 pandemic, investigating how compliant a general population is to mask-wearing policy. We combine object-detection-based convolutional neural networks, regression analysis and multilayer perceptrons to analyse visual data of the Viennese public during 2020. By comparing the predictive power of regression analysis and neural networks, we demonstrate that the neural networks provide more accurate predictions of population response during the COVID-19 pandemic. Furthermore, our use of regression modelling allows us to uncover possible causal pathways underlying societal behaviour. Since our findings underscore the importance of appropriate communication content, our work will facilitate more effective non-pharmaceutical interventions in future public health crises. Lastly, we demonstrate that the use of regression modelling and neural networks need not be mutually exclusive in the study of complex systems but can instead complement each other.

ABSTRACT Chronic depression associated with early trauma remains one of the most treatment-resistant conditions in mental health care. Clinical and empirical findings increasingly suggest that patients with histories of early trauma may benefit differentially from intensive psychoanalytic treatments compared to symptom-focused or short-term psychotherapies. This conceptual analysis aims to elucidate the mechanisms underlying sustained therapeutic change in psychoanalysis with chronically depressed, early traumatized patients by integrating clinical psychoanalytic theory, contemporary dream research, and interdisciplinary models of memory reconsolidation. Drawing on a detailed longitudinal case from the LAC Depression Study, the paper examines a patient who underwent high-frequency psychoanalysis and demonstrated enduring structural change that remained accessible more than a decade after treatment termination. Clinical material from the original analysis and from a later crisis intervention illustrates how early traumatic experiences – encoded as embodied, dissociated memory traces – can be reactivated within the transference relationship and gradually transformed through repeated analytic working-through. Particular emphasis is placed on changes in dream processes as indicators of deep psychic reorganization. Using psychoanalytically informed dream research, including the Zurich Dream Process Coding System (ZDPCS), the analysis demonstrates a shift from early trauma-dominated nightmares characterized by helplessness and absence of a helping object toward a later dream reflecting increased affect regulation, symbolic capacity, involvement, and self-agency. These transformations are conceptualized as markers of structural change rather than mere symptom reduction. The paper further argues that psychoanalytic processes resonate with contemporary neurobiological models of memory reconsolidation. When traumatic memories are reactivated within a safe and emotionally attuned analytic relationship, they may enter a labile state that allows for enduring modification and re-integration. From this interdisciplinary perspective, psychoanalysis is uniquely positioned to foster sustained change in patients with chronic depression and early trauma by enabling the re-transcription and reconsolidation of traumatic embodied memories within the analytic relationship. This conceptual integration contributes to a deeper understanding of why psychoanalysis can produce lasting therapeutic effects in a patient population traditionally considered difficult to treat.

Code Lavender: Recognizing and Responding to Emotional Crises Among Nurses.

Mobile crisis services offer a community-based alternative to law enforcement and emergency departments for individuals experiencing behavioral health crises. Medicaid claims represent a promising but underused tool for national surveillance of these services. Despite growing federal investment and expansion of crisis response systems, there is no standardized method for identifying mobile crisis encounters in administrative claims, limiting the ability to monitor access, evaluate implementation, or compare delivery across states. To develop and evaluate claims-based approaches for identifying mobile crisis service delivery in Medicaid administrative data. We conducted a cross-sectional analysis of 2021 Medicaid claims from the Transformed Medicaid Statistical Information System Analytic Files. We used the 2022 KFF Behavioral Health Services Survey data as the most recent standardized benchmark for Medicaid mobile crisis coverage. We tested 3 claims-based identification approaches that combine national and state-specific procedure codes (eg, H2011) with mobile-relevant place-of-service (POS) codes: strict [POS 15 (mobile unit)], moderate [POS 15 (mobile unit), POS 12 (home), or POS 04 (homeless shelter)], and inclusive [POS 15, POS 12, POS 04, or POS 99 (other)]. We additionally constructed a claims-based score summarizing state-level use of mobile-relevant POS codes and examined its alignment with reported coverage in exploratory analyses. Among 44 states and the District of Columbia with complete survey data, 33 reported Medicaid coverage of mobile crisis services. We identified 97,088 claims under the strict approach, 395,141 under the moderate approach, and 1,152,653 under the inclusive approach. Across all approaches, states reporting coverage had higher median claim counts than noncoverage states, though substantial overlap remained. Under the strict approach, median claim counts were 0 in both coverage and noncoverage states. The moderate approach demonstrated the greatest separation (median, 1324 vs. 364), while the inclusive approach captured larger volumes overall but with greater overlap between groups. Predicted probabilities derived from a claims-based score increased monotonically across score values, indicating stronger directional alignment with reported coverage at higher score levels. A claims-based approach combining mobile unit (POS 15), home (POS 12), and homeless shelter (POS 04) codes with crisis intervention procedure codes provides a practical framework for identifying billed mobile crisis encounters in Medicaid data. This moderate approach showed the strongest directional alignment with state-reported coverage and may support cross-state monitoring of crisis service delivery. Further work is needed to validate these methods using provider-level or encounter-level data.

ABSTRACT Background Suicide is the second leading cause of death among adolescents in the United States. Access to inpatient psychiatric treatment for adolescents experiencing suicidal crises remains limited, and existing care models often lack standardization in both structure and effectiveness. Intensive Crisis Intervention (ICI), a novel approach which includes cognitive–behavioral therapy, intensive family involvement, and individualized care, offers a promising alternative. While preliminary evaluations have described positive outcomes for patients, clinicians’ experiences with delivering ICI remain underexplored. Objective This qualitative study aimed to explore clinicians’ perspectives on implementing ICI in order to identify barriers and facilitators to its effective delivery and long-term sustainability. Method Participants were recruited from a larger study evaluating the feasibility, acceptability, and preliminary effectiveness of ICI. Crisis clinicians working in a youth crisis stabilization unit and delivering ICI participated in semi-structured interviews. Interview questions addressed topics such as training and support received for delivering ICI, experiences implementing specific components of the model, and clinicians’ perceptions of its benefits and challenges. Thematic analysis was used to analyze the interview transcripts. Results Eleven clinicians participated in the interviews, representing diverse professional backgrounds, including social work, clinical mental health counseling, and marriage and family therapy. Six themes were identified: (1) training needs, (2) perceived benefits of the ICI model, (3) challenges in practice, (4) operational barriers, (5) facilitators for ICI implementation, and (6) recommendations for future ICI. Conclusions Clinicians’ insights highlight the need for structured, and comprehensive training and institutional support to navigate the practical and ethical complexities of crisis care. These findings emphasize the importance of addressing structural and contextual barriers while strengthening team-based strategies to support the sustained implementation of ICI.