In a recent Crisis Jam discussion, Dr. Chris Carson, pioneer of the 23-hour observation model and Co-Founder of Connections, shared his insights on strengthening crisis care systems through the no wrong door model, medical leadership, and system-wide coordination. He emphasized the importance of direct access to psychiatric care, strong law enforcement partnerships, and operational efficiency to improve outcomes for individuals in crisis. 

Dr. Carson emphasized the importance of direct access to psychiatric care, reducing delays caused by unnecessary medical clearance. He highlighted the power of human touch in crisis services, ensuring that individuals receive compassionate care without unnecessary roadblocks.  The no wrong door approach ensures individuals receive the right care at the right time, without being turned away due to medical clearance requirements. Instead of defaulting to the emergency department (ED), individuals should be directly assessed for specialized psychiatric care whenever possible. 

Crisis centers must be flexible and responsive, designed to meet individuals where they are in their moment of need. Whether someone requires intensive care or just a quick resolution, crisis care needs to be tailored to the specific circumstances of the person seeking help. 

For high-acuity needs, observation units provide structured environments for intensive care, including involuntary holds when necessary. At the same time, lower-acuity needs—like medication refills—should be addressed without unnecessary barriers, ensuring everyone receives the right level of care. 

Dr. Chris Carson emphasizes that effective staffing is key. While there’s no one-size-fits-all approach, starting with Behavioral Health Technicians (BHTs) is essential. As frontline caregivers, BHTs deliver compassionate, safety-focused care. Equally vital are medical staff, including nurses, who help uphold a no wrong door approach, ensuring no one is turned away. A strong social services team also plays a crucial role in discharge planning, supporting smooth transitions and ongoing care. 

A critical challenge in crisis care is determining when medical stabilization is necessary versus when psychiatric intervention should take priority. Dr. Carson emphasized that individuals should have direct access to psychiatric care when there is no clear medical need for the ED. Seamless coordination between psychiatric and medical services is essential to delivering timely and appropriate care to patients. 

To facilitate this, a "freeway" system between EDs and crisis centers allows individuals to be quickly transferred if their medical or psychiatric needs change. This ensures that patients are not stuck in the wrong setting but instead receive the appropriate level of care without unnecessary delays. Fast, efficient movement between services is essential for improving outcomes and preventing system bottlenecks. 

Encouraging voluntary engagement in crisis care leads to better outcomes for individuals. However, when involuntary treatment is necessary, strong law enforcement partnerships play a crucial role. Direct drop-off protocols allow law enforcement officers to bypass the ED and bring individuals in crisis directly to psychiatric facilities, streamlining care and improving system efficiency. 

Dr. Carson highlighted that the real challenge in this approach isn’t just having law enforcement bring individuals directly to psychiatric care—it’s about taking responsibility for those individuals. While most cases can and should be managed within the crisis system, he acknowledged that there are times when medical intervention is necessary, and in those cases, transferring to a medical facility is the appropriate course of action. 

Crisis centers depend on strong medical leadership, effective staffing models, and efficient throughput to function properly. Psychiatric leadership is crucial for ensuring the no wrong door approach, taking responsibility for individuals instead of redirecting them elsewhere. This level of leadership requires both medical expertise and the ability to oversee and manage the entire system to ensure individuals receive the care they need. 

In summary, Dr. Carson’s insights from the recent Crisis Jam underscore the key elements of an effective crisis care system—direct psychiatric access, seamless medical coordination, and strong community partnerships. The no wrong door approach ensures individuals receive timely care without unnecessary barriers, while strategic staffing and medical leadership drive efficiency. By breaking down silos and strengthening collaboration, communities can create a crisis response system that delivers compassionate, immediate, and effective care when it’s needed most. 

SOURCE: "No Wrong Door" A Chat with Dr. Carson (ASL Version) - Ep 210 | 988 Crisis Jam