Walk-in behavioral health crisis stabilization services reduce ED visits

When people are having a mental health crisis, what are their options? Many patients may need to go to the emergency department (ED). An alternative to the ED is behavioral health crisis care (BHCC),defined as emergency behavioral health services available on a 24/7 walk-in basis to all patients, regardless of ability to pay. BHCC typically offer emergency psychiatric walk-in services, crisis intervention teams, suicide prevention services, and peer support specialists. BHCC also claim to be able to reduce inappropriate ED use…but do they in practice?

That is the question that a new paper by Burns et al. (2024) aims to answer. The use data from
2016-2021 SAMHSA’s National Directories of Mental Health Treatment Facilities to identify states with BHCC facilities and examine ED outcomes from AHRQ’s State Emergency Department Database (SEDD). The authors examined whether ZIP codes with more BHCC facilities–and BHCC facilities offering more comprehensive services–were correlated with lower rates of ED visits. (The authors also used pregnancy related ED use to control for secular trends in ED use largely unrelated to BHCC care).

Using this approach, the authors found that:

Walk-in crisis stabilization services were associated with reduced [mental, behavioral, and neurodevelopmental] MBD-related ED utilization (coefficient = −0.028, p = 0.009), 

This is very good prima facie evidence that BHCCs are good investments. Prevention of ED visits makes a strong case. However, additional research should examine the financial impact of increasing the number of BHCC facilities on health outcomes and cost. The cost analysis should look at both the cost of funding BHCCs and offsetting costs from fewer ED visits.

You can read the full paper here.