Community-Based Alternatives to a System’s Acute Care Needs
This article appears in the Crisis to Recovery issue of the National Council Magazine.
Current efforts to reform mental health care in the United States revolve around a perceived lack of inpatient psychiatric beds to assist those experiencing a mental health crisis. The solution is to develop community-based diversion strategies, including outpatient crisis stabilization centers and crisis residential treatment programs.
One such program is Progress Foundation’s Dore Street Urgent Care Center in San Francisco, a community-based response that provides acute behavioral health services, including 24/7 emergency crisis stabilization center and a 14-bed crisis residential program.
The Urgent Care Clinic provides assessment and triage responding to acute or escalating psychological crisis. By working closely with the San Francisco Police Department and other points of acute intervention, it diverts individuals facing involuntary treatment in an institutional setting to a community alternative. The Crisis Residential Treatment Program provides diversion from and an alternative to psychiatric, inpatient confinement in an intensive, 24-hour therapeutic environment. It primarily serves clients with a major mental health diagnosis and co-occurring substance abuse and/or physical health challenges
The most successful crisis residential programs emerge from a broad-based strategy of effective alternatives to hospitals, jails and other institutions. The San Francisco area is fortunate that the public mental health system views diversion from hospitalization as a priority and the crisis response system is part of a long-term strategy to implement a diversion policy.
Without adequate coordinated follow-up services available, an acute crisis program will face many of the same challenges as traditional hospital service to ensure the lasting effects of intervention. Crisis residential programs that do not have transitional residential treatment programs too often must refer clients to inadequate housing or poorly supported living settings.
Acute crisis residential treatment programs do not require traditional medical model staffing patterns to be effective. Moving beyond a traditional staffing hierarchy allows a program to recruit staff, licensed or not, who are at ease with clients experiencing extreme psychiatric distress. In fact, mixing a variety of experiences and perspectives can enhance the probability that clients will connect with one or more staff member during their stay.
The multiple crisis residential programs operated by Progress Foundation in urban San Francisco and rural Sonoma County serve as acute diversion programs with a “no-refusal” goal for admissions. This means that the program does not screen out specific types of client behavior (e.g., recent suicide attempts, violence or recent alcohol or substance abuse). In the rare situations that the program is not able to successfully divert, it is because of particular individualized situations, not behavior.
The Progress Foundation programs are based on a clinical practice called “social rehabilitation,” which emphasizes daily living skills, developing social-relational skills and the values of recovery and rehabilitation within a normalizing environment.