Mental Health Crisis Centers and EmPATH Units: Offering Care That Busy ERs Can’t
STAT examines how crisis receiving centers, mobile response teams and hospital-based EmPATH units can provide faster, calmer and more therapeutic care than crowded emergency rooms while helping more people return home safely.
Original reporting by Grace Rubenstein, STAT • April 26, 2024
What can specialized crisis care provide that a busy ER cannot?
Dedicated crisis centers and EmPATH units combine rapid psychiatric assessment with active treatment, peer support, food, rest and discharge planning in environments designed to lower distress. Instead of boarding on a hallway gurney while waiting for another placement, patients can begin recovering soon after arrival.
The emergency room has become America’s default entrance to psychiatric crisis care, even though most ERs were not designed for it. STAT reports that patients experiencing severe anxiety, depression, psychosis, suicidal thoughts or substance-use crises may wait for hours or days in noisy, restrictive settings with limited access to mental health specialists.
Crisis receiving centers, mobile teams and hospital-based EmPATH units offer a different continuum: respond earlier, treat the immediate crisis in the least restrictive appropriate setting and connect each patient with ongoing care.
The behavioral-health emergency by the numbers
Nearly 6M
U.S. adults visited emergency rooms for mental health emergencies in 2021—about one million more than in 2017.
3× longer
Patients with psychiatric needs wait in emergency rooms compared with patients who have medical needs.
>50%
Of U.S. emergency rooms and general hospitals have no psychiatry services, according to a 2022 survey.
Within 60 min
EmPATH units aim to connect every arriving patient with a psychiatrist.
The ER became the front door by default
Decades of underinvestment left the United States without enough community services or psychiatric beds. People in crisis often have nowhere easy to access except the emergency room, where teams must prioritize medical emergencies and may have little or no on-site psychiatric support.
The result is psychiatric boarding: patients remain in waiting rooms, hallways or treatment bays while awaiting evaluation or placement. The experience can worsen distress, increase agitation and expose both patients and staff to avoidable trauma.
1. Crisis centers begin with comfort and dignity
At Pima County’s Crisis Response Center in Tucson, children and teens spend time in a bright common room with rocking chairs, games and access to an enclosed outdoor patio. Adults rest in recliners in a quieter area. Patients receive regular meals and snacks, and they can participate in groups focused on emotional processing, coping skills and art.
These features support clinical care by addressing basic needs and helping patients feel safe enough to engage with staff.
2. Peer specialists make lived experience part of care
Peer-support specialists at the Tucson center have personal experience with mental illness or addiction and recovery. They sit with patients, share practical coping strategies and offer a kind of credibility and hope that traditional clinical roles may not provide on their own.
By asking what a person needs to feel better that day, the team frames care around collaboration rather than punishment or control.
3. EmPATH changes the physical and clinical environment
EmPATH units are hospital-based crisis settings built around an open “milieu” room. Patients can rest in recliners, walk around, play games, have snacks or make phone calls while staff observe from a central nursing station.
The design reduces reliance on isolation and one-to-one sitters. Just as important, it allows psychiatric evaluation and medication to begin quickly instead of making patients wait passively for an inpatient bed.
4. The goal is stabilization and a safe next step
EmPATH teams monitor progress and help patients return home with medication, follow-up care and a safety plan—often within 24 hours. When a patient needs substance-use treatment or inpatient psychiatric care, staff arrange that transition.
The short-stay model gives symptoms time to settle and clinicians time to determine the least restrictive setting that can safely meet the patient’s needs.
Evidence from the original EmPATH model
Scott Zeller, MD, helped develop the prototype EmPATH program at Alameda Health System in Oakland. STAT reports that a 2014 study found patients at the original unit boarded for an average of 1 hour and 48 minutes, compared with a statewide California average exceeding 10 hours.
While most psychiatric emergency patients in California were being sent to inpatient care at the time, the Alameda program admitted only 25%; the remainder were able to return home.
Newer programs are reporting operational gains
Research at the University of Iowa found that suicidal patients treated in an EmPATH unit were 60% more likely to have follow-up care established within a month of discharge.
Centra Lynchburg General Hospital in Virginia reported that during its unit’s first six months, mental health length of stay, inpatient psychiatric referrals and sitter costs each fell by about 20%. The reduction in sitter expense was estimated to save roughly $1 million annually.
Tucson connects crisis care beyond the hospital
Arizona’s model combines a crisis line, mobile response, a 24-hour receiving center, law-enforcement coordination and connections to ongoing treatment. The system accepts people regardless of insurance status and aims to resolve each crisis in the least restrictive appropriate setting.
STAT reports that 80% of Arizona’s 988 calls are resolved by phone. Mobile teams resolve 70% of the remaining cases in the field, and 60% to 70% of people who reach a crisis center ultimately return home rather than enter inpatient care.
988 creates an opportunity—and a capacity challenge
The national 988 Suicide & Crisis Lifeline received nearly five million calls in 2023, creating a clearer entry point for people who need behavioral-health help. But a phone number is only one part of a functioning crisis system: communities also need mobile teams, places that accept walk-ins and reliable outpatient care after the emergency passes.
As of 2023, nearly 1,800 mobile crisis teams and more than 600 crisis receiving or stabilization facilities were operating across the country, with additional programs planned. Service levels and access still vary widely.
What must change for crisis alternatives to scale
- Require equitable coverage: Insurance payment for psychiatric crisis care should reflect parity with physical emergency care.
- Pay transportation fairly: Ambulances need equivalent reimbursement for taking patients to crisis centers instead of ERs.
- Build supportive regulations: States need licensing standards that recognize mobile and receiving-center models.
- Coordinate the full system: Crisis lines, mobile teams, law enforcement, receiving centers, hospitals and outpatient providers must work together.
- Use the least restrictive setting: Care should preserve freedom and dignity while safely meeting clinical needs.
Article Highlights
- Nearly six million U.S. adults visited ERs for mental health emergencies in 2021.
- Crisis centers provide comfort, peer support and active psychiatric treatment outside the traditional ER model.
- EmPATH programs have reported shorter boarding, fewer inpatient admissions and stronger follow-up.
- 988’s success depends on mobile teams, receiving centers and sustainable reimbursement.
Original Reporting
Read Grace Rubenstein’s complete reporting, patient stories, interviews and national context from STAT.