Community-Based Crisis Care Beyond the Emergency Department: A Scoping Review

Suicide and mental ill-health remain a major global concern, reflected by rising emergency department presentations, however there is growing recognition that these settings often do not meet the needs of individuals in crisis. These settings are often experienced as crowded, traumatic, and poorly equipped for psychological distress, underscoring the need for accessible, community-based alternatives that offer safer, more supportive responses during crisis. This scoping review examines the needs, motivations, and experiences of people using community-based alternatives to emergency departments and explores how peer support and lived experience are embedded in these models. A scoping review was conducted across five academic databases and grey literature sources for publications from the last 20 years. Eligible records included any study design such as quantitative, qualitative, mixed-methods research, service evaluations, and descriptive reports. Records were required to describe short-term, community-based crisis services for adults. Studies involving telehealth, mobile crisis, or hospital-based care were excluded. Titles and abstracts were screened independently by two reviewers. Twelve papers (n = 8 mixed methods, n = 3 qualitative, n = 1 quantitative) were eligible for inclusion. Studies spanned five countries, were mostly published in the past decade, and examined a range of non-clinical crisis models, including crisis cafés, respite centers, stabilization units, and peer-led services. Interventions commonly supported people experiencing suicidal distress, acute anxiety, depression, or significant life stressors. Peer support was central in most models and linked to reduced distress, greater emotional connection, and, in some cases, lower ED use. Barriers included limited availability, geographical inaccessibility, funding constraints, and insufficient aftercare. The diversity of study designs and the limited evaluation data made it difficult to draw broader conclusions about the existing evidence. Long-term outcomes and economic impacts were rarely reported, and few studies compared peer-led and non-peer models. Place-based, community alternatives offer promising, person-centered options for people in distress and may complement existing suicide prevention efforts. Addressing accessibility and funding challenges, along with further research on outcomes and peer support, will help strengthen their role in crisis care.