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.