Are There Alternatives to Emergency Departments when Facing a Psychiatric Emergency?

Robert Haggard

Robert Haggard, CRSS
Recovery Support Specialist
Turning Point Behavioral Health Care Center, Skokie IL

The answer is a resounding yes, there are alternatives to emergency departments (EDs) for psychiatric emergencies. Person-centric, community-based crisis interventions found outside of traditional emergency departments serve a population with much-need, save lives and money, and offer hope. The Turning Point Behavioral Health Care Center (TP) where I work is a viable, safe, accessible, welcoming, warm, and caring space that has provided an alternative to EDs since 2011 with an amazing 97% deflection rate from the hospitals in its surrounding area.

Focusing on disabilities, shortcomings, tragedies, downfalls, heartaches, and misfortunes and labeling people are not what we are all about at TP. Instead, we refer to visitors—who are experiencing a wide variety of psychiatric crises—as “guests” as we visit with them in The Living Room (TLR) at TP.

The Living Room experience
Five days a week a savvy, dedicated team made up of two clinical supervisors, a psychiatric registered nurse, and peer counselors provide support, problem solving, verbal de-escalation, relaxation skills, community resources, and a variety of proven and effective interventions. Our goal is to empower our guests to implement coping skills and a plan of safety for the days that follow their visit to TLR. We actively listen, follow the direction of our guests’ needs as they determine them to be, and work together to address the crisis at hand. Intervention sessions last as needed from 1 to 5 hours and sometimes days, until the crisis is manageable.

Turning Point’s TLR project has possibly saved a few lives and acts as a safety net for those people in acute crisis who may have otherwise fallen through cracks in the system. Our professional team of peer counselors and clinical staff offer less intrusive and less clinical acute care in a far more enjoyable and nurturing environment than typical EDs. We support a wide array of experience and dedication to people in crisis. We provide a respite during stress-inducing times, such as gaps in insurance coverage, employment, or access to ongoing services and housing, or as part of aftercare programs for guests who have visited a psychiatric unit.

TLR model provides an alternative to connect with someone or to talk through a crisis rapidly without going through the rigors of an ED. Having people in crisis talk face-to-face with a peer counselor can be less costly to the health system and often a less disruptive experience for the guest. As a result, TLR has saved approximately $1.8 million through ED diversion while offering support and resources that are in high demand.

A growing alternative
TLR is a part of a movement of Alternatives to Emergency Departments (ALT EDs). The goal is to improve the experience of the individual by offering alternatives that are safe and welcoming at times of high stress which, in turn, can shift a person’s approach toward accessing care.

TLR was heavily influenced by an organization in Arizona, where the original “Living Room” idea organically germinated. Located throughout the country, these ALT EDs offer more cost-effective and person-centric interventions, functioning as reliable and trusted preventive health measures for people who choose to access care outside of the ED. Some ALT EDs have beds, some are paired with hospital EDs, and still others are in close proximity to police departments, courts, or hospitals.

Peer specialists are key to success
ALT EDs are staffed by peer specialists who have come to terms with their own diagnosed mental health condition. As such, they can relate to an experience personally or to something similar to that which the guests are experiencing. This empathic approach and honesty can break down barriers and form a bond enabling the individual to work things out more quickly than is often achieved in traditional therapies because the focus is on interventions in a safe, non-clinical, person-centric, community-based environment.

People in crisis are vulnerable and can experience interactions with police, the courts, or EDs as intimidating or scary. Offering alternative spaces to develop a plan that is driven by the individual can prove to be a more positive experience for a person experiencing acute crisis. That’s a win for everyone.

Would you consider receiving crisis care at an alternative facility rather than the hospital emergency department?

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13 comments
Eternal Optimism
Eternal Optimism

(Important Disclosure: Words in quotation marks are double entendre and should be read at surface level 1st read) Yes, before we do anything we tend to "overlook" the "Hope" for a continual breath of life, but what is the number of times you do not put such "infinitely perfect" "Hope" first? Selflessly, Ps. All breathing human beings that ascribe to whichever societal, traditional, and/or individual “construct,” believe in “Hope” with each breath given (despite the chosen form of “appearance.”).

Amie Hodges
Amie Hodges

My CSB uses the term consumer and it seems like an improper use of the word.

Stephanie Beaumont
Stephanie Beaumont

Love the usage of "guest." Words are important (which is why I loathe the term "consumer," bleh).

Asif Muhammad
Asif Muhammad

I Was 6 Year Old When Separated From Parents,,,,,,I Spent My Whole Life From 6 To Till 22 in My Uncle House,,,,,,,,From Beginning,,,,,,I Mean At Age of 6 Year,,,,I Have Differences With My Parents Especially With Father,,,,,My Father Is Totally Uneducated Person,,,,,My Father Is Hafiz, used by Muslims for someone who has completely memorized the Qur'an.So,,,,My Father Was An Uneducated But Hafizay Quran,,,,,My Father And My Whole Family Belongs To Deobandi Sect (The fundamentalist Deobandi Muslim sect, widely represented in the Indian subcontinent and among South Asian Muslims abroad, resembles its ally, the Saudi Wahhabi clergy, in many ways. Both claim to "reform" the religion. is a term used for a revivalist movement within Hanafi Islam.It is centered primarily in India, Pakistan, Afghanistan and Bangladesh, has recently spread to the United Kingdom, and has a presence in South Africa. The name derives from Deoband, India, where the school Darul Uloom Deoband is situated. The movement was inspired by the spirit of scholar Shah Waliullah (1703–1762), and was founded in 1867 in the wake of a failed revolt against British rule a decade earlier.........My Father Have Been Remained Many Years An Amir Of His Constituency,,,,,,,,,,,Amir Of Jema'ah(Group) Means That A Jama'at (Group) has 8 to 15 members with one leader or Amir who is usually chosen by the members themselves before the actual journey. They stay in Masjids (Mosques) along the way, and preach to the people who attend the Mosque. During the day, members of the Jama'at visit Muslim houses door to door and roam the markets of the town or village they have stayed in and exhort Muslims to lead a pure religious life and invite them to attend a sermon in nearby Mosque after certain prayers. Usually after the sermon, they encourage the attendees to come forward and join them on the spiritual journeys for a number of days they can spare. So,,,,,From The Beginning Of Childhood,I Was A Child Who Have Much Interest In TV Serials,,,,,Songs,,,,,Movies And Entertainment But,I Father Was Totally Opposite,,,,A Conservative And Religious Minded Person. At Age Of 6 Year,,,I Went To Uncle House,,,They Have Television In Their House,,,,My Uncle Is A Psycho Patient,,,,He Drinks And Don`t Do Any Work Whole Day,,,,,,So,I Encountered With A Psych Patient In Face Of My Uncle,,,,My Uncle Don`t Like me Due To My Father,,,,,My Uncle Hates With My Father So He Also Don`t Liked Me,,,,At Age Of 6,I Started To Suffer Fear And Compression In Form Of My Uncle,,,,As Time Goes On This Hate And Mental Torture Stated To Become Depression,,,,,At Early Stage,,,,I Don`t Know What Is Depression And Either I Have Depression,,,,Time Goes On,,,I Was Different From Other Children,,,,I Always Remain In Fear And Compression,,,,Don`t Have Much Activities Like Other Children,,,,So,,,,This Depression Goes On Goes On And Slowly Started To Have Practical Impacts On My Personality,,,,,My Childhood Database Started In Fear And Frightening,,,,,So,,,,This Depression Became Dysthymia(Chronic Depression)......It`s One Aspect Of my Life.

Robert Haggard
Robert Haggard

Thank you for commenting. Part of the point of the article is to point out benefits of ED alternatives to the many areas void of kind treatments to people experiencing psychiatric crisis. They are not in every community , yet. Though I feel they should be. Even our facility is only 4 years old in September of this year. So it is a relatively new modality and fiscally things are tight for mental health systems across the country. That said, I don't know what resources are in your area specifically. Search under crisis intervention, mental health crisis services and your location. You may be surprised at the resources you can find. Hope this is helpful. We are covered under grant funding at present, so there is no cost and we have pretty unlimited encatchment. The only stipulations preventing any access are pure safety measures and that people are not intoxicated. We refer outside in these cases so not to leave a person without resources. The #guests we have the privelage to serve recieve our undivided attention and care, through their crisis resolution.

Frances
Frances

Anything like this in South Carolina? ??

VondaleeDB
VondaleeDB

There is the Crisis Center of Tampa Bay for anyone who's interested. 

Smash the Stigma
Smash the Stigma

As someone who worked (admin) in an emergency department (Australia) I saw the horrors of the ED for patients. Unless they were clinging to life after a suicide attempt or accidental overdose they were called "frequent flyers" often made to sit for hours in a chair or worse still in the waiting room. If they were admitted to the department the goal (appeared to me) to never be about treatment but rather the goal was "stabilize to discharge." This model you describe is amazing. #guests must really identify and respond to this level of care. I'd love to see this type of person-centric care available in Australia.

Rockstargrrl
Rockstargrrl

Your hours aren't very conducive to crises though.  Who can schedule a crisis from 9-5 on some weekdays?  Try 3-10pm hours and then I might consider.

CRSS CHI
CRSS CHI

At TLR at Turning Point we are open 3-8 PM M - F & Su. When we are not open we have an Emergency Services Team on call 247/365. They are available by phone through our agency line. I don' know your location yet there is support by phone, computer, grass roots groups, apps, or through community and private mental health professionals across the United States. We work hard to reduce the barriers that prevent people from getting help if they want help.

Pickpink
Pickpink

I know there's one in Charlottesville, VA. Its very nice. I can't remember the exact name, but Google "crisis center" and the city/state and you should be able to find it.