The psychiatric emergency/crisis disposition and community networks

Recent advances in techniques of rapid neuroleptization have enabled psychiatric emergency/crisis intervention staff to stabilize many acutely ill patients in a brief time period, frequently less than 24 hours. This has resulted in less need for hospital admissions and has challenged the mental health field to develop alternative disposition options. These options can be classified through a "hierarchy of crisis placements." From least to most restrictive in dispositional context these are: (1) the patient's family, (2) emergency housing, (3) a foster home, (4) the crisis hostel, (5) the 24-hour holding bed facility or intensive observation apartment, (6) the crisis bed unit, and (7) inpatient hospitalization. The psychiatric emergency/crisis intervention unit serves as a gateway for these dispositions following emergency treatment. Thus, a primary function of the unit is the advocacy for, and coordination of, dispositional services, including those provided by a variety of community resources. The unit serves as a networking center that plays a central role in facilitating dialogue between mental health and social assistance agencies, which in turn leads to better follow-up planning and care for the mentally ill while avoiding unnecessary hospitalization and institutionalization.