Characteristics of individuals who are evaluated for service during a mental health crisis: Implications for Healthy Communities

Most states in the U.S. have established mechanisms in community-based mental health agencies to evaluate people experiencing a mental health crisis (e.g., manic episode) to determine needed treatment. Involuntary commitment to an inpatient psychiatric hospital is one option when a person in crisis refuses treatment, often due to the nature of the mental disorder or when community-based services are not available. A survey of all face-to-face crisis evaluations performed by trained clinicians over a period of 1 month in Virginia was conducted. Results indicated that 11% (n=421) of the evaluations were on juveniles and 87% (n=3,317) on adults. Among adults, about 24% were in the custody of the police at the time of the assessment. 41% of outcomes resulting in involuntary inpatient hospitalization, 14% voluntary inpatient, 5% received no treatment due to refusal and the person not being a danger to self or others, and the rest were referred to public or private outpatient treatment. Juveniles were significantly more likely to have insurance while 41% of adults had no insurance and 42% were not currently in treatment for their condition. Of adults, 86% presented with mental illness, 32% with substance abuse disorder, 3% mental retardation with many having co-occurring disorders. Clinicians reported that immediate medication evaluation by a psychiatrist, short-term crisis stabilization options, temporary housing and safe transportation would have enabled them to better treat patients. The relationship between available community resources and the occurrence of crisis-based involuntary inpatient hospitalization and treatment will be discussed.