Crisis Stabilization Unit Research Articles

Arkansas crisis stabilization unit guests: Baseline characteristics from a longitudinal cohort study.

Crisis Stabilization Units (CSUs) are short-term residential facilities that provide care to people experiencing mental health crises, seeking to reduce reliance on local emergency departments and avoid unnecessary jail detention. Despite these intentions, there is little foundational literature to support research on CSU efficacy and a dearth of research on the sociodemographic characteristics and specific needs of CSU patients. Here, we recruited and surveyed 208 participants admitted to one of two focal Arkansas CSUs on their sociodemographic characteristics, justice-involvement, mental health, substance use, and health care utilization. Results revealed that participants were mostly unemployed (68.16%), low-income (72.34%), and experiencing insecure housing (33.33%). They reported extensive justice-involvement (85.57%), high rates of clinically significant mental illness symptom severity (77.00% for anxious symptoms; 78.33% for depressive symptoms; 79.40% for traumatic stress symptoms), and recent substance use (73.34%). Recent engagement with other medical services was common, though more participants reported visiting an emergency department (42.23%) than did receiving outpatient medical care (26.73%). While research on CSU patient outcomes is needed, our results indicate that CSUs have the potential to be an essential part of the health care continuum by serving a population with multiple, intersecting needs and addressing a deficit in community-based crisis care. Continued investigation of community-based crisis intervention services is critical to bridging the gap between vital behavioral health resources and the populations in need of them. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Management of youth with suicidal ideation: Challenges and best practices for emergency departments.

Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self-harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self-harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home- and community-based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on-site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community- and home-based services, pediatric-receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.

Remodeling Broken Systems: Addressing the National Emergency in Child and Adolescent Mental Health.

A national emergency in child and adolescent mental health was declared in the United States in 2021 in the wake of the COVID-19 pandemic. This Open Forum discusses potential solutions to better support child and adolescent mental health by improving or expanding school-based mental health services, child psychiatry access programs, virtual mental health services, and new models of care (e.g., integrated youth services hubs and crisis stabilization units). The success of such programs is dependent on stable funding, strong leadership and accountability, robust and well-trained workforces, systems integration, and attention to health equity.

Study protocol paper for the multi-site feasibility evaluation of mobile and technology-assisted aftercare services for crisis stabilization units

BackgroundLaw enforcement frequently responds to substance abuse and mental health crises. Crisis stabilization units (CSUs) operate as a public-receiving facility to provide short-term stabilization services for individuals experiencing these crises and offer law enforcement an important alternative to arrest. However, there is limited understanding about how and when law enforcement decides to use CSUs. There is also the challenge of retaining individuals in treatment after CSU stabilization to prevent future crises and persistent engagement with police. This study will respond to these gaps by exploring CSU procedures and examining the feasibility and acceptability of a technology-assisted mobile aftercare intervention designed for individuals brought to a CSU by law enforcement.MethodsThis study will consist of three aims. Aim 1 will include qualitative interviews with law enforcement and CSU-affiliated mental health staff (n=80) regarding CSU utilization and collaboration logistics between the groups. Findings from Aim 1 will be synthesized for the development of an implementation guide of our intervention, mobile, and technology-assisted aftercare, designed for individuals brought to a CSU by law enforcement, during Aim 2. During Aim 2, intervention services will be pilot-tested for 6 months through a small sample (n=24), randomized control trial (RCT). Control participants will receive standard services available for individuals discharging from a CSU. Treatment participants will receive the mobile aftercare intervention. Qualitative and quantitative data will be collected at 2 weeks, 3 months, and 6 months post-recruitment for all study participants. Aims 1 and 2 will inform the design of a multi-site RCT to compare CSUs with and without mobile and technology-assisted aftercare (Aim 3).DiscussionThe study will offer decision making and procedural insight into law enforcement use of CSUs as an alternative to jail and provide opportunities to inform that process. This research will provide outcome trends for those who go through standard CSU services compared to those who receive mobile and technology-assisted aftercare services. The current study will inform a larger RCT efficacy study of CSUs with and without technology-assisted aftercare services.Trial registrationThis study was registered on ClinicalTrials.gov (reference #NCT04899934) on May 25, 2021.

Providing crisis care in a pandemic: a virtual based crisis stabilization unit.

Winnipeg, Canada operates a 16-bed subacute unit, the Crisis Stabilization Unit (CSU), for voluntary patients in crisis not requiring hospital admission. The virtual CSU (vCSU) launched in March 2020 as an adjunct to the in-person CSU during the COVID-19 pandemic, providing the same resources virtually, allowing patients to remain at home. Program data were collected for vCSU admissions between April 1, 2020 and April 7, 2021 (n = 266) to examine patient characteristics and discharge outcomes. Data were retrieved from the electronic patient record (EPR) for both in-person and vCSU admissions during the same period for comparison (n = 712). vCSU admissions (n = 191) were summarized by patient demographics, clinical factors/outcomes, and compared on the same measures to in-person CSU admissions (n = 521) using binary logistic regression. 30.1% of patients admitted to the vCSU received initial mental health assessment virtually (phone/videoconference), therefore receiving all care at home. Clinical symptoms at assessment included depression/anxiety (39.0%), psychosis/mania (2.7%), suicidal behaviour/self-harm (27.4%), psychosocial event/stressor (19.8%). Average stay was 4.9 days. Compared to the in-person CSU, vCSU referrals were associated with the absence of psychosis [odds ratio (OR).40, 95% confidence interval (CI).18-0.89] and no prior 1-year contact with referral site (OR.43, 95% CI.28-0.64). Those living farther away from the referral site were more likely to receive a vCSU referral. The vCSU model is feasible for a diverse group of patients experiencing mental health crises. Future work is needed to better determine who the model is right for and examine longer term outcomes.

A Qualitative Investigation of Preparedness for the Launch of 988: Implications for the Continuum of Emergency Mental Health Care

On July 16, 2022, the 988 mental health crisis hotline launched nationwide. In addition to preparing for an increase in call volume, many jurisdictions used the launch of 988 as an opportunity to examine their full continuum of emergency mental health care. Our goal was to understand the characteristics of jurisdictions’ existing continuums of care, identify factors that distinguished jurisdictions that were more- versus less-prepared for 988, and explore perceived strengths and limitations of the planning process. We conducted 15 qualitative interviews with state and local mental health program directors representing 10 states based on their preparedness for the 988 rollout. Interviews focused on 988 call centers, mobile crisis response, and crisis stabilization, as well as strengths and limitations of the 988 planning process. Data were analyzed using rapid qualitative analysis, an approach designed to draw insights on evolving processes and extract actionable findings. Interviewees from jurisdictions that reported that they were more-prepared for the launch of 988 tended to have local 988 call centers and already had local access to mobile crisis teams and crisis stabilization units. Interviewees across jurisdictions described challenges to offering a robust continuum of crisis services, including workforce shortages and geographic constraints. Though jurisdictions acknowledged the importance of integrating peer support staff and serving diverse populations, many perceived room for growth in these areas. Though 988 has launched, efforts to bolster the existing continuum will continue and hinge on efforts to expand the behavioral health workforce, engage diverse partners, and collect relevant data.

Crisis stabilization units for jail diversion: A preliminary assessment of patient characteristics and outcomes.

Crisis stabilization units (CSUs), which offer a range of short-term psychiatric and psychological services, are one of several treatment programs that may create "alternative to arrest" options for law enforcement. Here, we examined the characteristics of the population who was referred to a newly established CSU in its first year of operation and examined the impact of the CSU on regional jail bookings. Administrative medical records and regional jail booking data were merged to form our study sample. Adults who had at least one jail booking and/or one CSU admission during our study period were included. We found that from September 1, 2018 to August 30, 2019, 458 people were admitted into the CSU. Approximately one-third (33.8%) had a jail booking during the study period. In the 3 months following CSU admission, 4.1% had an increase in jail bookings, 11.1% had a decrease, and 66.2% had no change. CSU patients self-reported high depressive and posttraumatic stress disorder symptoms, while also reporting low quality of life scores overall. We conclude that CSUs may be promising components of jail diversion efforts, providing critical services to populations experiencing significant mental health symptoms and who are at risk for incarceration. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Needs Assessment of Clients Accessing a Community Mental Health Crisis Stabilization Unit.

This study aimed to examine the needs of clients accessing a community mental health crisis stabilization unit (CSU) in Winnipeg, Canada.Sociodemographics, service connections, and need were assessed among CSU clients. The Camberwell Assessment of Need Short Appraisal Schedule - Patient (CANSAS-P) was administered to differentiate need domains that were met and unmet. An ordinal regression examined sociodemographics and level of total unmet need; client characteristics were correlated with unmet need.In total,271 questionnaires were analyzed. On average, respondents had 6.2 areas of unmet need, with "psychosocial distress" (n = 186, 68.6%), "safety to self" (n = 140, 51.7%), "company" (n = 139, 51.3%), and "physical health" (n = 124, 45.8%) being reported most often. Higher level of unmet need was predicted by disability income and absence of income.Overall,CSU clients had high rates of unmet need reflecting important determinants of health. This information can inform community mental health crisis service delivery to positively impact mental health recovery.

San Diego officials tout success of mobile crisis teams to treat mental health and drug abuse

San Diego County officials touted the successes of a new specialized team that responds to people experiencing mental health and substance abuse crises, situations that were often previously handled by law enforcement, the Times of San Diego reported Feb. 28. The Mobile Crisis Response Teams (MCRTs), which are composed of mental health clinicians, case managers and peer support specialists, began services in January 2021 and are now available countywide. Those suffering from nonviolent crises are given assessments and crisis intervention services and linked to treatment and other services, according to the county. MCRTs are partnered with the Chula Vista and National City police departments — which refer calls to MCRTs when appropriate — though county officials say work is underway to establish partnerships with nine other jurisdictions. MCRTs have responded to 672 referrals and linked more than 110 people to treatment services, according to the county. Officials say 47% of the referrals have led to people gaining access to treatment options in their communities. County officials said the recent focus on behavioral health services has been beneficial, with the implementation of MCRTs and crisis stabilization units, which provide individuals with services in a community‐based or hospital setting. “These response teams are saving lives, demonstrating that this new approach to mental health is showing signs of real progress,” Supervisor Terra Lawson‐Remer said.

An Economic Analysis of the Cost of a Regional Crisis Stabilization Unit.

Crisis stabilization units (CSUs) are one type of "alternative to arrest" program used for jail diversion. We aimed to estimate the economic costs of starting and operating a CSU in Arkansas. We estimated the economic costs of the Pulaski County Regional CSU (PCRCSU) located in Little Rock, Arkansas, from September 1, 2018, to August 31, 2019. We collected data through interviews about start-up and ongoing management costs. We calculated total annual economic cost, average admission cost, and average 24 hr admission cost. There were 536 admissions to the CSU during the study period. The average length of stay was 60.27 hr. The total annual cost of the PCRCSU was $1,636,831 and average per admission cost was $3,054. Our results provide valuable economic data to government stakeholders who are considering establishing a CSU.

Sleep problems and complexity of mental health needs in adolescent psychiatric inpatients

Sleep problems are highly co-morbid with psychiatric disorders and are part of the complex and multiple factors contributing to symptoms and functional disability. The current study aimed to determine how sleep problems in the period preceding psychiatric admission relate to profiles of mental health needs in adolescent inpatients. This retrospective study included 424 adolescents (13–17 years) admitted over a five-year period to an acute crisis stabilization unit in a tertiary care pediatric hospital. Adolescents were divided into two age- and sex-matched groups based on the presence of moderate to severe sleep problems. Profiles of mental health needs were assessed at admission using the Child and Adolescent Needs and Strengths - Mental Health Acute (CANS-MH) and a complexity score was calculated as the total number of actionable CANS-MH items. Results showed a positive association between sleep problems and needs pertaining to eating disturbances, adjustment to trauma, and school attendance. Odds ratios for sleep problems increased progressively as the complexity scores increased, reaching a plateau at six needs beyond which odds ratios remained at their highest level. Adolescents with sleep problems were more likely to undergo medication changes during psychiatric hospitalization and were more likely to be discharged with antipsychotic medication. These findings suggest that sleep difficulties in adolescent inpatients may be associated with distinct and more complex profiles of mental health needs. The evaluation of sleep problems early in the course of psychiatric hospitalization may be an important part of the psychiatric assessment process to inform the global treatment plan.

Public Attitudes Regarding the Community Canadian Mental Health Association Crisis Stabilization Unit in Swan River, Manitoba

A door-to-door survey was conducted on households within a one square block of a Canadian Mental Health Association Crisis Stabilization Unit (Swan River, Manitoba, Canada). This was undertaken to examine the opinions and attitudes of the members of the surveyed households regarding the neighboring community mental health residence, as well as their general attitudes toward mentally ill individuals. The survey utilized preliminary questions to obtain personal characteristics of the respondents, which were followed by 11 short questions regarding attitudes towards mental illness and the neighborhood facility. The findings of this study agree with previous research suggesting a general receptiveness on the part of community residents to deinstitutionalization and to having community mental health residents as neighbors. The personal characteristic with the greatest positive influence on attitudes was previous personal contact with mentally ill individuals. However, it was found that a segment of the population holds negative attitudes towards the CSU. The author suggests that education of the community regarding the mental health facility and mentally ill persons may improve acceptance to a greater extent.

405 Crisis Stabilization Unit Reduces Admission Rates for Suicidal Patients in a Midwest Emergency Department

In an attempt to improve patient care and hospital operations, our institution implemented a crisis stabilization unit (CSU) to provide psychiatric stabilization and treatment in a setting other than the emergency department (ED). After initial evaluation and medical clearance by an emergency medicine provider, patients transfer from the ED to the CSU. The CSU aims to decrease the time, space, and monetary burdens on the ED, and to preserve the limited inpatient psychiatry beds for patients who truly need admission, as patients may discharge home from the CSU. The purpose of this study is to determine the effect on hospital admission rates for suicidal patients in the emergency department after the opening of the CSU in a rural academic medical center. We performed a before-and-after analysis of introducing the CSU within a Midwestern tertiary referral center. We evaluated study periods of November 15, 2017 to May 15, 2018 and November 15, 2018 to May 15, 2019 to examine patients pre- and post-CSU implementation. Adult patients presenting with suicidal ideation or suicidal attempt were included. The primary outcome was difference in proportion of inpatient psychiatric admission of suicidal patients presenting to the ED. Secondary outcomes compared were changes in proportion of any admission, use of code greens (code activated in cases where patient poses a threat, requiring immediate attention by psychiatry and security), incomplete admission (a bed request is made but the patient leaves prior to admission), restraint use, scheduling of follow-up within 30 days of discharge, ED returns within 30 days, and mean difference in ED boarding hours. We performed a descriptive analysis of patient visit characteristics presenting before and after CSU implementation. Association between categorical outcomes was determined to estimate relative risks (RR) and 95% confidence intervals (CI). Continuous outcomes were examined as the mean difference (MD) by time period. There were 962 patients presenting with suicidality (n=435 pre-CSU, n=527 post-CSU). There were no differences in population during the two study periods by age, sex, race, homelessness, or insurance. Compared to the pre-CSU period, there was a reduction in psychiatric admission (RR: 0.48; 95% CI: 0.40-0.56), any admission (RR: 0.65; 95% CI: 0.58-0.73), discharge after bed request (RR: 0.22; 95% CI: 0.11-0.43), 30-day return to the ED (RR: 0.74; 95% CI: 0.56-0.98), ED boarding time among admitted patients (MD: -9.0 hours; 95% CI: -13.5, -4.6) and incomplete admissions (MD: -12.5 hours; 95% CI: -21.3, -3.7). There was no significant difference in restraint use or code green use in the ED. There was a 60% increase in a 30-day follow-up being scheduled (RR: 1.60; 95% CI: 1.40-1.82). This study showed that the rate of any inpatient admission, discharge after bed request, 30-day ED return, and ED boarding time decreased after the implementation of the CSU.

The Vital Role of a Full Continuum of Psychiatric Care Beyond Beds.

The authors make the case for expanding the national discussion of inpatient psychiatric beds to recognize and incorporate other vital components of the continuum of care in order to improve outcomes for individuals with serious mental illness. They review the varied terminology applied to psychiatric beds and describe how the location of these beds has changed from primarily state hospitals to the criminal justice system, emergency departments, inpatient units, and the community. The authors propose 10 recommendations related to beds or to contextual issues regarding them. The recommendations address issues of mental illness terminology, criminal and juvenile justice diversion, the Emergency Medical Treatment and Labor Act, mental health technology, and the mental health workforce, among others. Each recommendation is based on findings from publicly available data and clinical observation and is intended to reduce the human and economic costs associated with severe mental illness by promoting a robust, interconnected, and evidence-based system of care that goes beyond beds.

Arkansas police, health professionals collaborate on crisis stabilization unit

Police and health professionals say they have a smoother process for working together now that the crisis stabilization unit in Arkansas' Washington County is open, the Arkansas Democrat‐Gazette reported Dec. 29. The 16‐bed unit where people may stay up to 96 hours is in Fayetteville. It is one of four units that comprise the state's pilot project to divert people with mental health problems from the criminal justice system. Washington County spent $250,000 to renovate a former juvenile detention center for the unit, and the state has committed to pay the operating costs of the facility through June 2021. Lt. Derek Wright of the Springdale Police Department described law enforcement and health professions as being “two completely different worlds” before the crisis stabilization unit. Police officers typically took people with suspected mental illnesses to the emergency room in hopes of getting them transferred to a behavioral health facility rather than jail, he said. “The emergency room is set up for medical care, not for behavioral health,” Wright said. Jessie Nelson, associate clinical director at Ozark Guidance, is among the mental health professionals who help teach officers about specific symptoms of various mental illnesses, such as schizophrenia, bipolar disorder and depression. What untrained officers may interpret as someone intentionally ignoring them may be involuntary behavior, she said. Fayetteville police officers Scott O'Dell and Garrett Levine said at a recent meeting of a regional advocate group, Judicial Equality for Mental Illness, that people with mental illnesses have been approaching police for help for a long time. “It's been going on for decades. It's just that now we have somewhere to take them,” Levine said.

3.57 COMPARISON OF READMISSION RATES BETWEEN YOUTH CRISIS STABILIZATION UNIT AND TRADITIONAL PSYCHIATRIC HOSPITALIZATION

Given the growing need for interventions that focus on acute adolescent suicide risk, coupled with limited access to mental health hospitalization, many communities have sought additional options to provide crisis intervention and stabilization in a secure setting. The purpose of the study is to examine readmission rates of a short-term youth crisis stabilization unit (YCSU) to determine whether they are comparable to traditional mental health hospitalization.

Innovations in Practice: Intensive crisis intervention for adolescent suicidal ideation and behavior - an open trial.

Adolescent suicide is a major public health concern worldwide. However, evidence regarding the effectiveness of interventions targeting youth suicide risk is limited. The purpose of this study was to assess the feasibility, acceptability, and clinical outcomes of Intensive Crisis Intervention (ICI), a cognitive-behavioral, family-centered treatment that provides an alternative to longer inpatient care. Intensive Crisis Intervention was piloted over a two-year period with 50 adolescents (Mage =15.1years; 86% Female; 78% Caucasian) admitted to an intensive crisis stabilization unit presenting with suicidal ideation and/or attempts. Data were collected at admission, 30days, and 3months post-admission to evaluate changes in suicidal ideation and functioning over time. Follow-up data were provided by 88% of study participants. At 3months, the mean Suicidal Ideation Questionnaire-Junior score improved 34.2 points relative to baseline (effect size of 2.2, p<.0001). Significant improvements in functioning, high rates of consumer satisfaction and readiness for care transition upon discharge were also reported. Study findings set the stage for a larger, randomized controlled trial to examine the efficacy of ICI in targeting suicidal ideation and behavior in adolescents.

Adolescents’ Experiences of Music Therapy in an Inpatient Crisis Stabilization Unit

Abstract Fourteen adolescents on an inpatient crisis stabilization unit were interviewed about their experiences of group music therapy in order to understand how sessions impacted their mental health recovery. Using analytic procedures consistent with qualitative content analysis, 13 preliminary themes captured their session experiences. From these themes, 4 central concepts emerged: (1) music therapy affirms participants’ strengths, (2) music therapy affirms coping resources, (3) music therapy integrates cognitive and affective processes, and (4) music therapy provides continuity of experiences. Each theme and concept is defined, along with implications for clinical implications and future research.

Relationship of peer specialists to mental health outcomes in South Florida

BackgroundIn recent years the use of peer specialists in the delivery of mental health of care across the US has increased. Although data on the benefits of using peer specialists is limited and/or equivocal, states are making policy and funding decisions to support the expansion of peer specialist services. This data is even more limited in the state of Florida where no studies were found to document the effect of peer specialists on mental health care outcomes. The purpose of this study was to assess whether local decisions to use peer specialists can be supported through the measurement of outcomes of service utilization and mental health functioning when peer specialists are involved in the treatment of individuals living with serious mental illness.MethodsThe study was conducted using service data collected by South Florida Behavioral Health Network (SFBHN). SFBHN is the Managing Entity for publicly funded mental health and substance abuse services in Miami-Dade and Monroe Counties in Florida. We compared mental health outcomes and service utilization between individuals who received peer specialist services (n = 367) and a treatment as usual group (n = 1468) matched on gender, age and severity of diagnosis in the period July 2013 and June 2015. Multilevel models were used to evaluate the functioning outcomes between the groups. Service utilization was assessed using negative binomial regression.ResultsIndividuals in the treatment group receiving peer specialist services utilized more ambulatory/lower levels of care services and had more frequent crisis stabilization unit admissions. Those in the treatment group also displayed more functional difficulties with a variety of practical activities, employment and housing and violent temper, hostility, threatening behaviors.ConclusionsThe findings of the study further support existing evidence documenting the mixed benefits of using peer services compared to treatment as usual care. Policy makers and other stakeholders are encouraged to advance mental health recovery by examining outcomes more comprehensively. Future research should include examination of the subjective benefits of peer support for recipients, understanding the impact on service utilization and a better definition of the roles, supervision and expectations of peer support programs.

"Psychological Boarding" and Community-Based Behavioral Health Crisis Stabilization.

This exploratory paper presents a case study where a community based mental health organization forging a partnership with a local hospital system to establish a crisis stabilization unit (CSU) to address behavioral health emergency care. The study takes a mixed methods case study approach to address two research questions; (a) did this approach reduce the overall length of stay in the hospital emergency departments? (b) What challenges did the taskforce face in implementing this CSU model? The paper shares recommendation from the findings.