RESEARCH WEEKLY: Availability of Walk-in and Crisis Outpatient Treatment Services in the United States
By Nina Robertson
The U.S. health care system is failing those with serious mental illness due, in part, to the lack of outpatient mental health crisis services available around the country, according to a study recently published in Psychiatric Services. Hospital emergency departments are considered the frontline services when triaging a mental health crisis. These settings are unable to provide adequate resources in a timely manner, which highlights the necessity for outpatient mental health crisis services to manage acute and subacute psychiatric events.
Outpatient mental health services offer various, specialized methods for individuals experiencing a mental health crisis such as verbal de-escalation, psychotherapeutic strategies, outpatient and inpatient referrals and treatment planning. This novel study published in Psychiatric Services examines the lack of these outpatient services in the form of walk-in services and crisis services around the country. The authors look into expansive policy options to remedy this national issue.
Study details
The authors examined temporal trends, geographic variation and characteristics of psychiatric facilities that provide emergency psychiatric walk-in and crisis services across the United States. They used cross-sectional, annually collected data that covered the 2014-2018 period from the National Mental Health Services Survey (N-MHSS) that is sponsored by SAMHSA. This representative survey accounted for all public and private mental health treatment facilities in the United States. It serves as the annual census of all U.S. mental health facilities curated in the National Directory of Mental Health Treatment Facilities and the Behavior Health Treatment Services Locator. U.S. Census Bureau data was utilized to calculate population-based rates of services per 100,000 adults in the United States. Both sets of data were merged to calculate state level trends of service availability.
Results
Analysis indicated that nearly half (42.6%) of all U.S. mental health facilities did not offer any mental health crisis services between 2014 and 2018. A third of all facilities offered emergency psychiatric walk-in services and just under one-half provided crisis services. Only 25% of all facilities in the United States provided both emergency psychiatric walk-in services and crisis services.
Between 2014 and 2018, walk-in and crisis services availabilities declined by 15.8% and 7.5%, respectively. N-MHSS data showed that facilities in the South offered the highest proportion of psychiatric walk-in and crisis services in comparison to the rest of the country.
Implications
The authors note that in light of the COVID-19 pandemic, the U.S. emergency management system has been stretched beyond capacity and resources are scarce. There is a significant need for licensed mental health facilities in the United States to expand provisions of crisis services. The sparse geographic availability of psychiatric care in many states such as Massachusetts, New Jersey, Texas, Florida and Delaware raises concerns about underdeveloped psychiatric emergency infrastructure in these regions. These disparities around the U.S. borders and coasts indicate necessary policy efforts to increase equitable access to services, according to the authors.
Outpatient settings are the largest component of the U.S. mental health system. Crisis care is often unavailable for those who cannot access adequate outpatient services. Results indicate a significant need for more mental health facilities that expand the availability of crisis services. The authors state that funding and policy must intersect to solve this national issue. They cite multiple, practical interventions such as an “increase in authorization and appropriation of funds, a 5% Mental Health Block Grant, increased funding for research and evaluation, additional payment mechanisms, and a central coordinating role for Congress.” The authors conclude by arguing that the mental health care system must take into account the effects of the ongoing COVID-19 pandemic. This should be done alongside physical health care to allow those with serious mental illness to access the care they deserve.
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