The Crisis Now Library

Making better crisis care available in your area is closer than you think.

The Crisis Residential Best Practices Handbook

…published with permission of tbdSolutions.

WHITE PAPER – Crisis Now Policy Recommendations Report

View the Crisis Now Report to see implementation recommendations for the transforming crisis services.

ASSESSMENT – Framework for State/Region Self-Assessment

Use this assessment to rate your state or local regions crisis framework from minimally to fully integrated.

BUSINESS CASE – Exceptional Practices Lead to System’s Success

Quantifying Improved Crisis Continuum Outcomes.

INFOGRAPHIC – Outcomes for Expense, Hospital & Law Enforcement

In 2016, metropolitan area Phoenix law enforcement engaged nearly 22,000 individuals that they transferred directly to crisis facilities and mobile crisis without visiting a hospital ED. This is Crisis Now.

ACTION ALLIANCE – Crisis Services Task Force

CrisisNow Report: Transforming Services is Within Our Reach

Trend in Psychiatric Inpatient Capacity, United States and Each State, 1970-2014

Tenth in a Series of Ten Briefs Addressing: What Is the Inpatient Bed Need if You Have a Best Practice Continuum of Care?

The Role of Permanent Supportive Housing in Determining Psychiatric Inpatient Bed Capacity

Second in a Series of Ten Briefs Addressing: What Is the Inpatient Bed Need if You Have a Best Practice Continuum of Care?

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

Nearly 10 million individuals in the United States are estimated to live with a diagnosable psychiatric condition sufficiently serious to impair their personal, social, and economic functioning.

Crisis Services Role in Reducing Avoidable Hospitalization

Fourth in a Series of Ten Briefs Addressing: What Is the Inpatient Bed Need if You Have a Best Practice Continuum of Care?

Crisis Now | Transforming Crisis Services
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Breaking News

Crisis Report

NHSCC and RI International publish recommendations...

Latest Recommendation

Be the Change

Ensuring an effective response at all...

The Challenge

After reviewing approaches to crisis care across the United States, the Crisis Services Task Force of the National Action Alliance for Suicide Prevention (Action Alliance) believes now is the time for crisis care to change. The Task Force, established to advance objective 8.2 of the National Strategy for Suicide Prevention (NSSP), comprises many experts, including leaders who have built and operate many of the most acclaimed crisis programs in the nation.

After reviewing the literature and model programs, these leaders built the Crisis Now report to suggest what can be done, galvanize interest, and provide a road map for change. Our comprehensive review finds that now is the time for crisis services to expand because of a confluence of factors and forces, including:
  • Crisis care often being the preferred and most efficient care for people in crisis
  • The absence of core elements of successful crisis care in many communities
  • Mental health reform proposals that are on the table but fail to seize the opportunity to improve crisis care
  • Mental health parity legislation and coverage expansion

EDs Face Challenges Addressing Behavioral Emergencies

The Task Force has studied elements of successful programs and reviewed their effectiveness. While some communities are crisis-ready, there are very few communities where all key elements of crisis care are in place, and many where even the “parts” of crisis care that exist are inadequate. In short, core elements of crisis care include:

  1. Regional or statewide crisis call centers coordinating in real time
  2. Centrally deployed, 24/7 mobile crisis
  3. Short-term, “sub-acute” residential crisis stabilization programs
  4. Essential crisis care principles and practices
  5. Develop and implement protocols for delivering services for individuals with suicide risk in the most collaborative, responsive, and least restrictive setting
These elements are discussed in more detail in the report ( download here ). Effective crisis care that saves lives and dollars requires a systemic approach, and these key elements must be in place. The report also reviews proven key components of good crisis care and demonstrates that piecemeal solutions are unacceptable.

Four Core Elements For Transforming Crisis Services

High-Tech Crisis
Call Centers

These programs use technology for real-time coordination across a system of care and leverage big data for performance improvement and accountability across systems. At the same time, they provide high-touch support to individuals and families in crisis.

24/7 Mobile
Crisis

Mobile crisis offers outreach and support where people in crisis are. Programs should include contractually required response times and medical backup.

Crisis Stabilization
Programs

These programs offer short-term “sub-acute” care for individuals who need support and observation, but not ED holds or medical inpatient stay, at lower costs and without the overhead of hospital-based acute care.

Essential
Principles & Practices

These must include a recovery orientation, trauma-informed care, significant use of peer staff, a commitment to Zero Suicide/Suicide Safer Care, strong commitments to safety for consumers and staff, and collaboration with law enforcement.

National Association of State Mental Health Program Directors

(NASMHPD)

Technical Assistance Coalition Assessment Working Papers

BeyondBeds-PaperCover

More papers here:

• TA Coalition Assessment Working Papers

• Beyond Beds: The Vital Role of a Full Continuum of Psychiatric Care

• Crisis Services’ Role in Reducing Avoidable Hospitalization

ReducingHospitalization-PaperCover

Other Important Papers include:

• Trend in Psychiatric  Inpatient Capacity, United States and Each State, 1970-2014

• The Role of Permanent Supportive Housing in Determining Psychiatric Inpatient Bed Capacity

The Crisis Now Impact

Crisis Now saves time and operating costs by improving access to care.

Rate Your Local Crisis System

The assessment and programmatic scoring guide.

CrisisNow-HowYourSystemRate
The Crisis Now Report

Transforming services is within our reach

Recommendation 1:

Effective Crisis Care Must Be Comprehensive and Include The Core Elements of Crisis Care

  1. Regional or statewide crisis call centers coordinating in real time
  2. Centrally deployed, 24/7 mobile crisis
  3. Short-term sub-acute residential crisis stabilization programs
  4. Essential crisis care principles and practices
  5. Recovery orientation
    • Trauma-informed Care
    • Significant Use of peer staff
    • Commitment to Zero suicide/Suicide Safer Care
    • Strong commitment to safety of consumers and staff
    • Collaboration with law enforcement

Recommendation 2:

Crisis Call Services Should Participate in and Meet the Standards of the National Suicide Prevention Lifeline, and crisis Intervention Systems Should Adopt and Implement Zero Suicide/Suicide Safer Care Across all Program Elements

  • Leadership-driven, safety-oriented culture committed to dramatically reducing suicide among people under care, which includes survivors of suicide attempts and suicide loss in leadership and planning roles
  • Develop a competent, confident and caring work force
  • Systematically identify and assess suicide risk among people receiving care
  • Ensure every individual has a pathway to care that is both timely and adequate to meet his or her needs and that includes collaborative safety planning and reducing access to lethal means. Use effective, evidence-based treatments that directly target suicidal thoughts and behaviors
  • Provide continuous contact and support, especially after acute care
  • Apply a data-driven quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk

Recommendation 3:

State and National Authorities Should Review the Core Elements of Air Traffic Control Qualified Crisis Systems, Apply them to Crisis Care in their Jurisdictions, and Commit to Achieving These Capabilities Within 5 Years, So That Each Region of the U.S. has a Qualified Hub for Crisis Care:

Link mobile crisis and crisis beds to the call center. Use air traffic control objectives:

      • Always know where the individual in crisis is (in time and space) and never lose contact
      • Verify the hand-off has occurred and the individual in crisis is safely in the hands of another provider

Status Disposition for Intensive Referrals

      • 24/7 Outpatient Scheduling
      • Shared Bed Inventory Tracking
      • High-tech GPS-enabled Mobile Crisis Dispatch
      • Real-time Performance Outcome Dashboards

For additional information about the Crisis Now recommendations download the full report:

For additional crisis readiness strategies and documents check out the Crisis Now Library:

Watch The Videos

The Retreat Model is Today

Transforming Crisis Services in Arizona

Air Traffic Control Model

How Does Your Crisis System Flow?

Calculate Your Local Crisis Need

The volume estimation and clinical distribution guide.

HowDoesYourCrisisSystemFlow

Crisis Providers Improve Care, Reduce Cost, And Relieve ER Overload

Good crisis care reduces and prevents suicides while providing more immediate and targeted help for the person in distress. In addition, it cuts cost of care substantially by reducing the need for psychiatric hospital bed usage, emergency department visits, and law enforcement overuse. In general, mental health crisis care in the U.S. is inconsistent and inadequate. Members of the Crisis Services Task Force of the National Action Alliance for Suicide Prevention (Action Alliance) created the Crisis Now concept and authored the Crisis Now paper; identifying the exceptional practices desired in a crisis services.

Responses to questions will be answered by representatives of agencies involved in the creation of the Crisis Now Report.