When preparing to release a solicitation for a crisis response center (CRC), it’s essential to focus on securing the necessary licensing and understanding regulatory requirements. Providing clear and detailed information about your community’s licensing framework is crucial for ensuring that potential providers can operate smoothly and without unexpected interruptions. 

We are thrilled to announce that Connections Kirkland has been honored with the prestigious 2024 Senior Housing News (SHN) Architecture & Design Award in the Behavioral Health Category. This award recognizes the most innovative and thoughtfully designed behavioral health facilities, and we are incredibly proud that our center in Kirkland, Washington, has been selected as the winner. 

Establishing and maintaining a crisis response center is crucial for effective mental health care, but it requires a well-thought-out strategy to ensure financial sustainability. Many U.S. cities have not invested sufficiently in these essential services, highlighting a significant funding gap. The National Council for Mental Wellbeing underscores that crisis response centers are as vital as law enforcement and emergency medical services, demanding sustainable funding to function effectively. 

Writing a solicitation to identify a provider to build and/or operate a comprehensive crisis response center is a complex endeavor that requires a thorough review of the current crisis continuum in the community to identify any existing gaps and barriers. Before writing a Request for Proposal (RFP) for a crisis center response, local stakeholders must carefully consider the questions they will pose to potential respondents. These questions are crucial for ensuring that the selected provider aligns with community needs, adheres to national standards, and demonstrates a clear approach to care.  

Across the U.S., county governments are at the forefront of transforming behavioral health crisis response. The launch of the 988 Suicide and Crisis Lifeline, along with the growing presence of mobile crisis teams, has intensified the focus on establishing Crisis Response Centers (CRCs). These centers are vital for alleviating the burden on first responders, hospitals, and detention centers – which currently serve as a default solution for those in crisis. 

With 75 percent of the U.S. population reliant on county-based behavioral health services through more than 750 county-supported or operated behavioral health authorities, it is essential that counties looking to partner on the operations of a CRC create concise and effective requests for proposals (RFPs). 

A well-designed crisis care system has the potential to transform how individuals in need access timely and appropriate support. Central to this vision are crisis centers, which provide immediate interventions for those experiencing behavioral health emergencies. 

When a mental health crisis is averted, the journey to recovery is far from over. Comprehensive discharge planning is paramount to ensure individuals receive the ongoing support necessary for stabilization and to prevent future crises. A continuum of crisis programs, each tailored to varying levels of need, is essential for providing care in the least restrictive, most appropriate setting. 
 
For those who no longer require intensive crisis intervention but still benefit from a supportive environment, lower acuity crisis programs offer a vital step-down level of care. These programs, often housed in home-like settings, provide a non-institutional atmosphere staffed primarily by peers and behavioral health clinicians. Services may include medically monitored detoxification or clinically managed sobering programs, depending on the facility's medical capabilities. Lengths of stay vary from under 24 hours in living rooms to several days or weeks in crisis residential programs. These programs play a crucial role in preventing or shortening inpatient admissions by offering a bridge to less intensive community-based services. 
 
Urgent care clinics serve as a critical link to outpatient services, providing same-day access to assessment, crisis counseling, medication management, and care coordination. Staffed by psychiatrists, nurse practitioners, social services staff, and often peer support specialists, these clinics function as the front door to the crisis system. Individuals can receive immediate attention, with the option for admission to a higher acuity 23-hour observation unit if necessary. Without urgent care, individuals may face extended waits for outpatient appointments, allowing their condition to potentially escalate. 
 
Comprehensive discharge planning from crisis programs must consider the individual's ongoing needs and the availability of services in their community. This includes connection to outpatient therapy, support groups, and case management services, as well as addressing basic needs like housing and financial stability. By coordinating with community providers and social services agencies, crisis programs can ensure a smooth transition and reduce the likelihood of future crises. 
 
Investing in a continuum of crisis programs, from intensive intervention to lower acuity step-down services and urgent care, is essential for providing the right level of care at the right time. Comprehensive discharge planning is the thread that weaves these services together, setting the stage for sustained recovery.

When a mental health crisis strikes, every minute counts. Yet, during an emergency, individuals often face agonizing waits of a month or more for a therapy appointment, and even longer to see a psychiatrist. This delay can allow a precarious situation to escalate, necessitating an even higher level of care. Crisis response centers must integrate walk-in urgent care services to address this critical gap. 

Crisis stabilization units (CSU) provide inpatient-level care for individuals requiring secure, intensive monitoring beyond the 23-hour crisis observation period. Like inpatient units, CSUs feature 24/7 nursing, daily contact with psychiatrists, and an average three-to-five day stay. Having an on-site CSU ensures continuity of care, avoids treatment delays and duplicative efforts, and prevents individuals from being stuck in observation units due to inpatient bed availability.  

23-hour crisis observation units aim to quickly assess needs, initiate treatment, and plan for discharge to ensure ongoing stabilization in the least restrictive setting. An interdisciplinary team uses various interventions—such as medications, peer support, family involvement, and care coordination—to address crises and resolve psychosocial barriers. 

One of the core goals of crisis services is to reduce unnecessary emergency department visits and jail bookings by providing readily accessible behavioral health care.  A dedicated receiving function at crisis centers plays a pivotal role in this mission, offering a 24/7 entry point for individuals in need through walk-ins, emergency department transfers, and direct drop-offs by first responders. 

The delivery of mental health services in emergency settings remains a significant challenge. Fragmented systems often struggle to provide the appropriate level of care at the critical moment when a person's crisis peaks. Comprehensive crisis centers offer a solution to this problem by integrating multiple levels of service within a single, coordinated system. 
 
The "no wrong door" approach is central to the comprehensive crisis model. Irrespective of how an individual presents, the center is equipped to immediately initiate assessment and treatment. This eliminates the risk of a person in crisis being denied care due to lack of availability or inappropriate levels of service. 
 
The comprehensive crisis center comprises four core components: 

A well-designed crisis care system has the potential to transform how individuals in need access timely and appropriate support. Central to this vision are crisis centers, which provide immediate interventions for those experiencing behavioral health emergencies. 

Arizona has evolved its crisis response system over the past 15 years, establishing a model that emphasizes coordination, accessibility, and fiscal responsibility. At the heart of this transformation is a managed Medicaid structure, a robust funding strategy, and a commitment to treating individuals in the community.

Oftentimes, people experiencing mental health and substance abuse-related problems end up incarcerated. How do we ensure that individuals in crisis are receiving the proper response, treatment, and services?   

In the realm of mental health much has been done over the past few years to advance the crisis response system. Leading the charge is the state of Arizona, who has charted a remarkable course, sculpting a system with four key components that form the backbone of an effective crisis response system. Let's delve into these pillars that collectively contribute to a comprehensive and impactful system.

A "No Wrong Door" crisis response center (CRC) is an approach that revolutionizes how first responders and law enforcement partners can help individuals in crisis get treatment instead of the alternative of jail or languishing in the emergency department (ED) waiting for a bed. Centers who operate as a “no wrong door” facility have become pivotal in reshaping the narrative around mental health emergencies.

With an increase in fentanyl across the globe, Connections Health Solutions’ chief of quality and innovation officer, Dr. Margie Balfour, spoke to what Connections is doing and how crisis response centers can help. 

“Part of our mission is to get people into treatment instead of in the justice system,” Dr. Balfour stated.   

When 911 is called for a mental health crisis, the default response is often law enforcement rather than mental health professionals - but a proven response model is looking to change that.

In the United States, a community's response to a behavioral health crisis is often fragmented, inefficient, and inaccessible to those who need it most. In most communities, few treatment options are designed for and capable of safely managing the care of individuals in crisis. Additionally, the capacity of behavioral health services, both inpatient and outpatient, has struggled to keep up with rising patient volumes and requests for services. This challenge has been made worse by workforce shortages across the industry.   

As leaders in the behavioral health crisis care space, we often are asked, “What defines a crisis?”. At Connections, we believe a behavioral health crisis is determined by the individual. We describe it as an emergent situation where an individual finds themselves unable to cope with their thoughts, emotions, or circumstances. A failure to resolve such a situation could potentially endanger oneself or others. Common indicators of a crisis include struggling with suicidal thoughts, substance misuse, anxiety, psychosis, or social issues.

Delivering immediate, high quality behavioral health crisis care to people in need is a team effort. At Connections Health Solutions, our team is comprised of individuals who each possess a different background and level of expertise, from the mental health professionals who work in our centers to the members of law enforcement we collaborate with in the communities we serve throughout Arizona, Montana, and soon Virginia and Washington state. Peer support specialists bring a unique type of experience to crisis care, making them an invaluable member of the Connections care team, as well as a person’s journey.

People experiencing mental health crises can't afford to wait - but with behavioral health urgent care centers and the 23-hour observation model, they now have access to care in hours rather than days.

At a time when mental health costs are skyrocketing, one innovative model is delivering care at a fraction of the cost of traditional ER and hospital visits.

23-hour observation programs may seem straightforward on the surface, but it's the specific components and protocols that separate the most effective programs from the rest.

When 911 is called for a mental health crisis, the default response is often law enforcement rather than mental health professionals - but a proven treatment model is looking to change that.

As of April 2023, states were able to resume Medicaid redeterminations and terminations of coverage for those no longer eligible, potentially putting millions of individuals at risk of losing coverage.

In the United States, the increasing demand for behavioral healthcare among youth is met with challenges, leading to unnecessary hospital visits and prolonged stays in inpatient facilities. Limited community resources often result in disproportionate school discipline or justice system involvement for youth with behavioral health needs. SAMHSA created behavioral health crisis care guidelines to improve outcomes for youth and their families.