Mental Health Crisis Services Research Articles

HHS approves New Mexico's community‐based care expansion

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services, has approved a proposal from New Mexico for community‐based mobile crisis intervention teams to provide Medicaid crisis services, a cms.gov news release stated. The Feb. 6 announcement is the latest in HHS' ongoing efforts to support President Biden's whole‐of‐government strategy to transform mental health services for all Americans — a key part of the President's Unity Agenda, the news release stated. New Mexico is the 15th state to expand access to community‐based mental health and substance use crisis care through President Biden's American Rescue Plan. With this approval, the state will be able to provide Medicaid services through mobile crisis teams by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days a year. This work builds on HHS' broader work to expand dramatically the full continuum of mental health crisis services, including through the nationwide launch of the 988 Suicide & Crisis Lifeline and expansion of Certified Community Behavioral Health Clinics under the Bipartisan Safer Communities Act, providing crisis services 24 hours a day, 7 days a week, regardless of a person's ability to pay.

How can we improve mental health crisis services for young people? A survey of mental health crisis professionals across Greater Manchester

BackgroundHealthcare providers have been under pressure to improve the provision of crisis mental health services in England. Through the process of devolution, Greater Manchester has created the Crisis Care Pathway to meet the growing demands on mental health crisis service provision for young people in the city region. At the end of the first funding cycle, this research evaluated the pathway with a focus on potential future improvements.MethodsAn online survey, including a mixture of quantitative, Likert scale items and qualitative, open-ended questions, was completed by 60 professionals working within crisis mental health services for young people in Greater Manchester.ResultsAnalysis of the quantitative data identified 6 clear areas for improvement from the evaluative indicators: delivering support at a time that works for young people; delivering the right amount of help for the right length of time; providing services which are quickly available; services and agencies working together effectively; movement between services; fully integrated services. A further 3 super-ordinate themes were developed through thematic analysis of the qualitative data that indicate areas in need of improvement: The challenge of navigation, issues of accessibility into and between services, and how to improve integration.ConclusionsThis research found 7 clear actions to enhance the provision of crisis mental health services for young people in Greater Manchester, which may be transferable to other mental health crisis service contexts.

Competencies Emergency and Mental Health Nurses Need in Triage in Acute Mental Health Care: A Narrative Review

IntroductionEmergency and mental health nurses are, in many countries, the designated professionals to conduct acute mental health triage. This review aimed to identify competencies these nurses need in major acute health care services such as emergency and accident departments and mental health crisis services for triage for psychiatric patients in crisis. MethodsFor familiarization and construction of an initial thematic framework, we have searched the databases MEDLINE, CINAHL, Academic Search Premier, and PsycINFO since 1975. For indexing and sorting, the web-based application Rayyan was used to identify relevant studies. ATLAS.ti 22 was used for data extraction, reviewing, summary, and display using labels relevant for our research questions: knowledge, skills, and attitude. For appraisal of the included studies, the Mixed Methods Appraisal Tool and the Scale of the Assessment for Narrative Reviews were used. ResultsThirty one studies were included and were overall rated as adequate, mostly published since 2000. Competencies needed by nurses in AMHT contain a high level of specialist knowledge (risk assessment, de-escalation, triage tools, psychopathology, law/regulations, care pathways), skills (clinical skills, communication, collaboration, coordinating care), and attitude (nonjudgmental, confidence). DiscussionEmergency and mental health nurses require a significant amount of competencies beyond basic nursing education in acute mental health triage. Most described competencies pertain both to knowledge and skills. Less is known about attitude. To integrate the several competencies knowledge, skills, and attitude, clinical reasoning is needed to organize chaos in unpredictable and complex patient situations.

3.64 Barriers and Facilitators of School-Based Mental Health Crisis Services

3.64 Barriers and Facilitators of School-Based Mental Health Crisis Services

Developing 'Comprehend, Cope and Connect' Training for Acute and Crisis Mental Health Services: Staff, Patient and Carer Perspectives

'Comprehend, Cope and Connect' (CCC) is an evidence-based psychological intervention for psychological crisis designed for use in inpatient settings. The aims of the current study were to gain the perspectives of multidisciplinary team (MDT) staff, patients and carers to inform the design of a potential CCC training programme for MDT staff to deliver CCC interventions. Staff, patient and carer perspectives on developing a CCC training programme were collected through video call-based group consultations and written feedback. Thematic analysis was employed to organise and explore latent themes within the data. Thirteen MDT inpatient staff and an expert patient and carer panel of four participated in the study. Feedback showed that the CCC model supported staff in understanding patients beyond labels in a patient-centred and led capacity, and that CCC was helpful in bringing clarity to crisis. Staff participants stated that learning and practicing psychological skills and encouraging confidence would be important when training staff in CCC. They identified needs to embed CCC into ward culture and integrate CCC with care planning for successful implementation of CCC in inpatient settings. The patient and carer panel focused on the needs of patients, concluding that CCC training should emphasise the need to understand patient experience, and promote compassion and empathy. These findings provide evidence for what staff, patients, and carers consider to be important when training MDT staff to deliver CCC interventions in an inpatient setting and form a foundation for implementation of CCC training.

Explaining context, mechanism and outcome in adult community mental health crisis care: A realist evidence synthesis.

Mental health crises cause significant distress and disruption to the lives of individuals and their families. Community crisis care systems are complex, often hard to navigate and poorly understood. This realist evidence synthesis aimed to explain how, for whom and in what circumstances community mental health crisis services for adults work to resolve crises and is reported according to RAMESES guidelines. Using realist methodology, initial programme theories were identified and then tested through iterative evidence searching across 10 electronic databases, four expert stakeholder consultations and n = 20 individual interviews. 45 relevant records informed the three initial programme theories, and 77 documents, were included in programme theory testing. 39 context, mechanism, outcome configurations were meta-synthesized into three themes: (1) The gateway to urgent support; (2) Values based crisis interventions and (3) Leadership and organizational values. Fragmented cross-agency responses exacerbated staff stress and created barriers to access. Services should focus on evaluating interagency working to improve staff role clarity and ensure boundaries between services are planned for. Organizations experienced as compassionate contributed positively to perceived accessibility but relied on compassionate leadership. Attending to the support needs of staff and the proximity of leaders to the front line of crisis care are key. Designing interventions that are easy to navigate, prioritize shared decision-making and reduce the risk of re-traumatizing people is a priority.

Crisis care for children and young people with mental health problems: national mapping, models of delivery, sustainability and experience (CAMH-Crisis2). A study protocol.

One in six five 16-year-olds have a probable mental health difficulty. Of these, almost half of older teenagers and a quarter of 11-16-year-olds report having self-harmed or attempted suicide. Currently, there is little research into mental health crisis services for young people, with little understanding of what services exist, who uses them, or what works best. 'How are mental health crisis responses for children and young people up to the age of 25 sustained, experienced and integrated within their local systems of services'? 1. To describe National Health Service (NHS), local authority, education and third sector approaches to the implementation and organisation of crisis care for children and young people across England and Wales.2.To identify eight contrasting case studies in which to evaluate how crisis services have developed and are currently organised, sustained, experienced and integrated within the context of their local systems of services.3.To compare and contrast these services in the context of the available international evidence, drawing out and disseminating clear implications for the design and delivery of future crisis responses for children and young people and their families. A sequential mixed methods approach, underpinned by normalisation process theory will be employed. A survey will create a detailed record of how crisis responses across England and Wales are organised, implemented and used. Subsequently, eight contrasting services in relation to geographic and socioeconomic setting, populations served, and service configuration will be identified as case studies. Interviews will be conducted with children, young people and parents/carers who have used the service, as well as commissioners, managers and practitioners. Operational policies and service usage data will also be examined. Analysis of how each service is provided, experienced, implemented and sustained will be conducted both inductively and deductively, reflecting normalisation process theory constructs.

Rates and associations of relapse over 5 years of 2649 people with bipolar disorder: a retrospective UK cohort study

BackgroundEvidence regarding the rate of relapse in people with bipolar disorder (BD), particularly from the UK, is lacking. This study aimed to evaluate the rate and associations of clinician-defined relapse over 5 years in a large sample of BD patients receiving routine care from a UK mental health service.MethodWe utilised de-identified electronic health records to sample people with BD at baseline. Relapse was defined as either hospitalisation, or a referral to acute mental health crisis services, between June 2014 and June 2019. We calculated the 5-year rate of relapse and examined the sociodemographic and clinical factors that were independently associated with relapse status and the number of relapses, over the 5-year period.ResultsOf 2649 patients diagnosed with BD and receiving care from secondary mental health services, 25.5% (n = 676) experienced at least one relapse over 5 years. Of the 676 people who relapsed, 60.9% experienced one relapse, with the remainder experiencing multiple relapses. 7.2% of the baseline sample had died during the 5-year follow-up. Significant factors associated with experiencing any relapse, after adjustment for relevant covariates, were history of self-harm/suicidality (OR 2.17, CI 1.15–4.10, p = 0.02), comorbidity (OR 2.59, CI 1.35–4.97, p = 0.004) and psychotic symptoms (OR 3.66, CI 1.89–7.08, p < 0.001). Factors associated with the number of relapses over 5 years, after adjustment for covariates, were self-harm/suicidality (β = 0.69, CI 0.21–1.17, p = 0.005), history of trauma (β = 0.51, CI = 0.07–0.95, p = 0.03), psychotic symptoms (β = 1.05, CI 0.55–1.56, p < 0.001), comorbidity (β = 0.52, CI 0.07–1.03, p = 0.047) and ethnicity (β = − 0.44, CI − 0.87 to − 0.003, p = 0.048).ConclusionsAround 1 in 4 people with BD in a large sample of people with BD receiving secondary mental health services in the UK relapsed over a 5-year period. Interventions targeting the impacts of trauma, suicidality, presence of psychotic symptoms and comorbidity could help to prevent relapse in people with BD and should be considered in relapse prevention plans.

Indiana lawmaker sees latest gains setting stage for more MH support

The Indiana state legislature's lead sponsor of a bill to expand the reach of the state's crisis mental health services said he believes the gains that were made in this year's legislative session bode well for more progress in coming years.

Crisis care for children and young people with mental health problems: national mapping, models of delivery, sustainability and experience (CAMH-Crisis2). A study protocol.

Background One in six five -16-year-olds have a probable mental health difficulty. Of these, almost half of older teenagers and a quarter of 11–16-year-olds report having self-harmed or attempted suicide. Currently, there is little research into mental health crisis services for young people, with little understanding of what services exist, who uses them, or what works best. Question ‘How are mental health crisis responses for children and young people up to the age of 25 sustained, experienced and integrated within their local systems of services’? Objectives 1. To describe National Health Service (NHS), local authority, education and third sector approaches to the implementation and organisation of crisis care for children and young people across England and Wales. 2. To identify eight contrasting case studies in which to evaluate how crisis services have developed and are currently organised, sustained, experienced and integrated within the context of their local systems of services. 3. To compare and contrast these services in the context of the available international evidence, drawing out and disseminating clear implications for the design and delivery of future crisis responses for children and young people and their families. Methods A sequential mixed methods approach, underpinned by normalisation process theory will be employed. A survey will create a detailed record of how crisis responses across England and Wales are organised, implemented and used. Subsequently, eight contrasting services in relation to geographic and socioeconomic setting, populations served, and service configuration will be identified as case studies. Interviews will be conducted with children, young people and parents/carers who have used the service, as well as commissioners, managers and practitioners. Operational policies and service usage data will also be examined. Analysis of how each service is provided, experienced, implemented and sustained will be conducted both inductively and deductively, reflecting normalisation process theory constructs.

Family involvement, patient safety and suicide prevention in mental healthcare: ethnographic study.

Family involvement has been identified as a key aspect of clinical practice that may help to prevent suicide. To investigate how families can be effectively involved in supporting a patient accessing crisis mental health services. A multi-site ethnographic investigation was undertaken with two crisis resolution home treatment teams in England. Data included 27 observations of clinical practice and interviews with 6 patients, 4 family members, and 13 healthcare professionals. Data were analysed using framework analysis. Three overarching themes described how families and carers are involved in mental healthcare. Families played a key role in keeping patients safe by reducing access to means of self-harm. They also provided useful contextual information to healthcare professionals delivering the service. However, delivering a home-based service can be challenging in the absence of a supportive family environment or because of practical problems such as the lack of suitable private spaces within the home. At an organisational level, service design and delivery can be adjusted to promote family involvement. Findings from this study indicate that better communication and dissemination of safety and care plans, shared learning, signposting to carer groups and support for carers may facilitate better family involvement. Organisationally, offering flexible appointment times and alternative spaces for appointments may help improve services for patients.

Oregon Pilot Program Would Expand MH Crisis Services for Youth

Oregon Pilot Program Would Expand MH Crisis Services for Youth

Fulfilling the Goals of 988 Through Crisis Stabilization Care.

Recent implementation of the nationwide 988 Suicide and Crisis Lifeline has expanded telephone-based mental health crisis services and created a unified framework for crisis care in the United States. However, the infrastructure for the final step of the crisis continuum-an appropriate mental health service for persons in crisis to receive the care they need-is fragmented, unevenly distributed, underfunded, and understudied. Given the few options for individuals in crisis, most often inpatient psychiatric hospitals are the default option. In this Open Forum, the authors describe the scope of the problem and propose how clinicians, policy makers, and researchers can improve the availability of evidence-based disposition options for individuals in crisis.

Variations in the uptake of telemental health technologies in community and crisis mental health services during the early pandemic: a survey of mental health professionals in the UK

One of the many challenges faced by mental health services during the COVID-19 pandemic was how to deliver care during lockdown. In community and crisis services, this often meant rapidly adopting or expanding the use of telemental health technologies, including phone and video calls. The aim of this study is to explore variations in use and report staff views of such technologies during the early stages of the pandemic. The primary analysis compared rates of use between professions, demographic groups, genders, regions, and crisis and community services. We used data from an online survey conducted by the Mental Health Policy Research Unit in Spring 2020 regarding the impact of the pandemic on mental healthcare in the United Kingdom. We included quantitative data from all professional groups working in community or crisis services providing care to working age adults, including general and specialist services. Our outcome of interest was the percentage of clients whom clinicians primarily interacted with via videocall. We also collected demographics and professional characteristics such as the type of mental health service respondents worked in. In addition, we explored respondents' views and experiences of telemental health as a medium for providing care. 978 participants were included in the primary analysis (834 provided outcome data for community services, 193 for crisis services). In community services, virtually all staff reported stopping some or all face-to-face appointments following the onset of the pandemic, with a large majority using video or phone call appointments where possible instead. Telemental health use was higher in community than in crisis services, and amongst professionals who mainly provided psychotherapy or peer support than in other groups. There was also evidence of use being lower in regions in Northern England, Scotland, and Wales than elsewhere. There was no evidence of an association with staff gender, age, or ethnicity. Staff were generally positive about telemental health and intended to make more use of technologies following the pandemic. However, significant barriers to its use were also reported, often involving skills and available infrastructure. Despite its rapid implementation, telemental health was viewed positively by clinicians who saw it as an effective alternative to face-to-face appointments in some contexts, including during the pandemic. However, adoption of the technology also has the potential to exacerbate existing or create new inequalities without effective management of training and infrastructure needs.

Growing inequities in mental health crisis services offered to indigent patients in Puerto Rico versus the US states before and after Hurricanes Maria and Irma.

To assess changes in the availability of mental health crisis services in Puerto Rico relative to US states before and after Hurricanes Maria and Irma. National Mental Health Services Surveys conducted in 2016 and 2020. Repeated cross-sectional design. The independent variable was mental health facility location in Puerto Rico or a US state. Dependent variables were the availability of three mental health crisis services (psychiatric emergency walk-in services, suicide prevention services, and crisis intervention team services). The proportion and per 100,000 population rate of facilities offering crisis services were calculated. The availability of crisis services at mental health facilities in Puerto Rico remained stable between 2016 and 2020. These services were offered less at indigent care facilities in Puerto Rico than US states (e.g., 38.2% vs. 49.5% for suicide prevention, p=0.06) and the magnitude of difference increased following Hurricane Maria. There are disparities between Puerto Rico and US states in the availability of mental health crisis services for indigent patients.

A single-group pilot feasibility and acceptability study of the Broad Minded Affective Coping technique for suicidal adults in crisis

The evidence base for psychological interventions for suicidal individuals is limited and the delivery of longer-term therapy within mental health crisis services is confronted by several barriers. For these reasons, identifying briefer techniques that can be delivered to at-risk groups is pertinent. This study provides a preliminary evaluation of the Broad Minded Affective Coping (BMAC) technique, a brief positive mental imagery intervention, for suicidal adults. Of 32 individuals referred by mental health crisis services, 14 adults with experience of suicidal ideation in the past three months took part. All participants received a one-session BMAC brief intervention, and invited to practice the BMAC independently for the next seven days and provide logbook ratings of pre-post BMAC mood states. Suicidal ideation and depression were assessed at baseline and at the end of the week of imagery practice. Nine participants (64%) completed the study by providing baseline and follow-up assessments of depression and suicidal ideation, completing a logbook and participating in a feedback interview. The BMAC appeared acceptable to participants and showed promise in improving mood and suicidal thoughts. We discuss the implications of these findings for future investigations of a one-session BMAC brief intervention.

National Suicide Prevention Lifeline 2020 In-State Answer Rates, Stratified by Call Volume Rates and Geographic Region.

Back to table of contents Previous article Next article DatapointsFull AccessNational Suicide Prevention Lifeline 2020 In-State Answer Rates, Stratified by Call Volume Rates and Geographic RegionJonathan Purtle, Dr.P.H., M.Sc., Michael A. Lindsey, Ph.D., M.S.W., Ramesh Raghavan, Ph.D., Elizabeth A. Stuart, Ph.D.Jonathan PurtleSearch for more papers by this author, Dr.P.H., M.Sc., Michael A. LindseySearch for more papers by this author, Ph.D., M.S.W., Ramesh RaghavanSearch for more papers by this author, Ph.D., Elizabeth A. StuartSearch for more papers by this author, Ph.D.Published Online:14 Jul 2022https://doi.org/10.1176/appi.ps.202200020AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail On July 16, 2022, the number 988 will become the new toll-free dialing code for the National Suicide Prevention Lifeline (the major crisis telephone hotline in the United States) (1). Lifeline calls are initially routed to crisis centers within the caller’s state. If the call cannot be answered in a reasonable amount of time, it is rerouted to an out-of-state crisis center. Answering calls within the same state as the caller is considered to be a best practice because crisis center staff can effectively connect callers to local resources. The “in-state answer rate”—defined as the percentage of Lifeline calls originating from a state that are answered in that state—is a Lifeline quality metric, with 90% being the benchmark goal. This analysis characterized variation across states’ in-state answer rates and assessed associations with rates of Lifeline call volume and geographic region.State-level 2020 data on in-state answer rates and number of Lifeline calls—excluding calls from veterans (state mean=25.0% of calls) and Spanish speakers (state mean=1.4% of calls), because callers from these populations are routed to separate Lifelines—were obtained from publicly available Lifeline reports (2). Using data from the U.S. Census Bureau (3) and Department of Veterans Affairs (4), we estimated the number of nonveteran residents within each state in 2020. We used these data to calculate a rate of Lifeline calls per 1,000 nonveteran state residents. This served as a population size–adjusted measure of demand for Lifeline services.The mean±SD in-state answer rate was 71.3%±19.5%, and the range was 10.0% (Minnesota) to 98.2% (Rhode Island). Only seven states were at or above 90.0%. Mean in-state answer rates by U.S. Census region were as follows: Northeast, 76.1%; West, 76.7%; South, 70.6%; and Midwest, 62.7% (F=1.32). The mean Lifeline call volume rate per 1,000 nonveteran state residents was 5.54±1.33, and the range was 3.75 (Maine) to 11.00 (Alaska). No correlation was found between a state’s in-state answer rate and its Lifeline call volume rate (Spearman correlation=−0.11, Pearson correlation=0.06) (Figure 1).FIGURE 1. National Suicide Prevention Lifeline 2020 in-state answer rates and call volume rates for each U.S. stateaa The line is the correlation between in-state answer rate and call volume per 1,000 residents for all 50 states.We found a substantial variation in Lifeline in-state answer rates across states. The absence of an inverse correlation between in-state answer rates and call volume rates suggests that low in-state answer rates are not the result of high demand for Lifeline services. Understanding how to improve in-state answer rates is important because Lifeline call volume is projected to potentially triple following the launch of the new 988 dialing code (5).Department of Public Health Policy and Management, Global Center for Implementation Science, School of Global Public Health (Purtle), McSilver Institute for Poverty Policy and Research (Lindsey), and Silver School of Social Work (Raghavan), New York University, New York City; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Stuart).Send correspondence to Dr. Purtle ([email protected]). Tami L. Mark, Ph.D., and Alexander J. Cowell, Ph.D., are editors of this column.The authors report no financial relationships with commercial interests.References1 Hogan MF, Goldman ML: New opportunities to improve mental health crisis systems. Psychiatr Serv 2021; 72:169–173Link, Google Scholar2 National Suicide Prevention Lifeline State Reports. Rockville, MD, Substance Abuse and Mental Health Services Administration. https://suicidepreventionlifeline.org/lifeline-state-reports/. Accessed Jan 8, 2022Google Scholar3 State Population Totals: 2010–2020. Suitland, MD, US Census Bureau, 2021. https://www.census.gov/programs-surveys/popest/technical-documentation/research/evaluation-estimates/2020-evaluation-estimates/2010s-state-total.html. Accessed Jan 8, 2022Google Scholar4 National Center for Veterans Analysis and Statistics. Washington, DC, US Department of Veterans Affairs. https://www.va.gov/vetdata/veteran_population.asp. Accessed Jan 8, 2022Google Scholar5 988 Appropriations Report. Rockville, MD, Substance Abuse and Mental Health Services Administration, 2021. https://www.samhsa.gov/sites/default/files/988-appropriations-report.pdfGoogle Scholar FiguresReferencesCited byDetailsCited byGrowing inequities in mental health crisis services offered to indigent patients in Puerto Rico versus the US states before and after Hurricanes Maria and Irma8 November 2022 | Health Services Research, Vol. 50 Volume 74Issue 2 February 01, 2023Pages 204-205 Metrics KeywordsCrisis interventionSuicide and self-destructive behaviorPublic policy issuesPDF download History Received 9 January 2022 Revised 14 March 2022 Accepted 20 May 2022 Published online 14 July 2022 Published in print 1 February 2023

The Rapid Evolution of Crisis Mental Health Services in Utah: Opportunities and Challenges as a Result of the Global Pandemic.

Our country is facing a resurgence of behavioral health crises from over the past 30 years, further illuminated and exacerbated by the global COVID-19 pandemic. Increasing suicide crises among youths over recent decades, untreated anxiety and depression, and serious mental illness are signs of the need for improvements in accessible, affordable, timely, and comprehensive behavioral health services. Against the backdrop of high suicide rates and low behavioral health services in Utah, statewide collaborators aligned with a common goal: deliver crisis services to anyone, anytime, and anywhere. After its initiation in 2011, the integrated behavioral health crisis response system continued to expand and excel, ultimately improving access and referral to services, flattening suicide rates, and reducing stigma. The global pandemic further motivated the expansion of Utah's crisis response system. This review focuses on the unique experiences of the Huntsman Mental Health Institute as a catalyst and partner in these changes. Our goals are to: inform about unique Utah partnerships and actions in the crisis mental health space, describe initial steps and outcomes, highlight continuing challenges, discuss pandemic-specific barriers and opportunities, and explore the long-term vision to improve quality and access to mental health resources.

Centering equity in mental health crisis services.

Centering equity in mental health crisis services.

Distinguishing the need for crisis mental health services among college students.

[Correction Notice: An Erratum for this article was reported online in Psychological Services on Aug 19 2021 (see record 2021-78000-001). In the original article, the Method heading that appears above the Crisis Walk-In Sessions heading should appear instead as the Results. All versions of this article have been corrected.] The increasing frequency of college students' use of crisis mental health services at college counseling centers is exacerbating the existing challenges college counseling centers face to meet students' growing demand for mental healthcare on campus. The purpose of the present study was to investigate whether any clinical or demographic variables distinguished between students in the clinical population who did and did not use crisis services, including crisis walk-in sessions and transport to the hospital for emergency psychiatric evaluation. Clinical and demographic data from the intake paperwork of 408 students who received services from a university counseling center over a 2-year time-period were collected and analyzed to determine whether any variables were associated with significantly higher levels of crisis service use. Only prior use of self-harm as a coping strategy was associated with both increased likelihood of accessing crisis walk-in sessions and hospital transports. Black students were more likely to use crisis walk-in sessions than White students and students with a history of prior counseling were more likely to attend multiple crisis walk-in sessions. A higher likelihood of being transported to the hospital was associated with history of prior counseling, suicidal ideation at intake, higher scores on the Counseling Center Assessment of Psychological Symptoms-62 depression and social anxiety subscales, and use of one versus multiple crisis walk-in sessions. Results are discussed in the context of how counseling centers might employ these findings to identify students who are more likely to require crisis services and target interventions proactively to mitigate this need. (PsycInfo Database Record (c) 2022 APA, all rights reserved).