Crisis Stabilization

Abigail Frierson, deputy county manager of Clark County, Nevada, described why her county built a crisis stabilization center: “Without a facility like this, first responders really only have two options for folks experiencing behavioral health crisis, and that’s the emergency room or jail.”

Crisis stabilization centers are the third option. SAMHSA’s 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care define them as subacute facilities providing “immediate, short-term psychiatric stabilization” outside the emergency department and jail system. In practice, they receive people in acute behavioral health crisis, provide clinical evaluation and stabilization over hours to days, and connect patients to ongoing care before discharge.

Crisis stabilization centers exist because the two systems that have historically received people in behavioral health crisis — emergency departments and jails — document their own inadequacy for this function. Forty-six percent of emergency departments lack psychiatric consultation services; 59% must transfer psychiatric patients elsewhere. Jails house people with mental illness at documented rates above the general population but provide treatment to fewer than half of them. Emergency physicians, law enforcement officials, and judges have each described the status quo as unsustainable in their own terms.

The SAMHSA 2025 National Guidelines identify this as a longstanding gap now addressed by a convergence of federal guidance, state investment, and the 988 Lifeline infrastructure.

Dr. Chad Koyanagi, Hawaii’s Department of Health mental health director, describes crisis stabilization as “an urgent care for psychiatric treatment” — an analogy that captures the model’s position in the care continuum but does not fully distinguish it from emergency departments, psychiatric hospitals, sobering centers, and mobile crisis teams that may already exist in a jurisdiction. Each distinction matters for program design.

Dr. Margaret Balfour’s research on psychiatric crisis care describes the operational standard at well-designed centers as “no wrong door”: the person or first responder is not turned away, but assessed and either stabilized or transferred to an appropriate setting. SAMHSA’s 2025 National Guidelines formalize this standard as the design target for crisis facilities.

Two peer-reviewed studies provide the primary independent research on crisis stabilization centers as of 2025: Burns et al. (2025) on emergency department diversion, and the Arizona State University / Connections Health Solutions study (2024) on patient reutilization. Program-reported data from Arizona’s AHCCCS system provides cost and impact figures cited in legislative contexts.

Crisis stabilization centers are operating or under active development in more than 40 states. The geographic spread is broad, but the distribution is uneven: dense in states that have made crisis stabilization a legislative priority, thinner in states without dedicated funding or Medicaid reimbursement infrastructure, and often absent in rural areas where construction costs and population density make standalone facilities difficult to sustain.

A Safer Cities national survey of 2,414 registered voters found 89% effective ratings and 82% community support for crisis stabilization centers. Support remained at 69% even after voters were reminded of competing budget priorities.

Crisis stabilization centers sit at the intersection of behavioral health, law enforcement, emergency medicine, and courts. SAMHSA’s 2025 National Guidelines identify stakeholder engagement as a prerequisite for successful implementation.

The Burns et al. 2025 study and Arizona’s program-reported data document real outcomes. So do the closure records from Arkansas, Montana, Sonoma County, and Nevada. This card documents both the positive and negative.

SAMHSA’s 2025 National Guidelines describe a set of design decisions each jurisdiction must address when building crisis stabilization centers. This card documents what cities have chosen at each decision point and what the sources report about outcomes.

Crisis stabilization centers require two distinct funding streams to operate sustainably: capital funding to build or acquire the facility, and operational funding to run it year after year. These streams come from different sources, serve different purposes, and carry different political dynamics. The Northwest Arkansas CSU collapse followed a pattern in which ARPA and state capital funds built the facility but encounter-based operational revenue was insufficient to sustain it.

Ohio Republican Mike DeWine and Atlanta Democrat Andre Dickens have each used the same argument about ER overcrowding and jail cycling in their public advocacy for crisis centers. Safer Cities polling tested message performance with 2,414 registered voters and identified which arguments produce the highest net positive ratings.