What Is This?

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.

How They Work

The operating model is deliberately distinct from both a hospital emergency room and a psychiatric inpatient unit. The physical environment is designed to be non-clinical: living rooms with couches, natural light, and sensory-calming spaces rather than exam bays. The Psychiatric Times describes the interior design principle at leading centers as “homelike and hospitality-oriented dormitory-style rooms” that “give some privacy and reinforce dignity.” Cleveland’s center was built with “a living room model intake area to feel less clinical,” staffed by peer support specialists alongside clinical professionals.

Salt Lake City’s Huntsman facility operates with 200 mental health professionals, including psychiatrists, nurses, and peer specialists. The Daily Memphian documented Memphis’s model as including “psychiatrists, nurses, counselors and social workers.” The SAMHSA 2025 National Guidelines describe the core staffing elements as including licensed clinicians for assessment and medication management, nurses for medical monitoring, and peer support specialists for engagement, with staffing depth varying by scale and scope.

The SAMHSA 2025 National Guidelines describe the care timeline as designed for brief stabilization — shorter than inpatient psychiatric hospitalization and longer than a typical emergency department stay. The guidelines identify three care levels that documented programs have implemented:

23-hour observation: A person is assessed, stabilized, and connected to a discharge plan within a 23-hour window. The Psychiatric Times notes this threshold reflects a design choice to keep facilities below the billing trigger point for inpatient admissions. Dr. Chad Koyanagi, medical director for Hawaii’s Department of Health Mental Health Division, describes this level as “an urgent care for psychiatric treatment.”

3-to-5-day crisis stabilization: For people who need more time to stabilize. SAMHSA’s 2025 guidelines identify this tier for people with medication adjustments, complex co-occurring presentations, or insufficient discharge support systems. Birmingham, Alabama’s Craig Crisis Care Center, for example, maintains 32 temporary beds for short-term stays alongside 16 extended-stay beds.

Up to 14-day residential: Available at some facilities for people who need sustained stabilization before transitioning to outpatient treatment or longer-term residential care. Salt Lake City’s Huntsman Mental Health Institute facility maintains both 23-hour observation capacity and a short-term stabilization unit with average stays of seven days.

SAMHSA’s 2025 National Guidelines describe multiple entry pathways as a design standard: self-referral, family-accompanied, ambulance, police, and mobile crisis team transport. The center at Roanoke, Virginia, part of the Blue Ridge Behavioral Health Care Center, describes itself as a “crisis campus” where “anyone can access the care,” according to Allison Taylor, the facility’s Division Director of access to care. Many facilities build specific infrastructure for first responder drop-offs: Memphis’s 55,000-square-foot center has a dedicated drop-off area with key card access so officers can complete a handoff quickly and return to patrol.

Multiple documented centers have adopted no-cost, no-insurance-required access policies. Memphis’s center provides services “free of charge and regardless of health insurance status.” Fort Collins, Colorado’s center is “open to all Larimer County residents of all ages regardless of their ability to pay.” DuPage County, Illinois board chair Deborah Conroy told the Daily Herald the county’s center “will accept patients of all ages, with or without insurance.”

Where It Fits in the Response System

Crisis stabilization centers occupy the third position in the framework that SAMHSA’s 2025 National Guidelines formalize as the essential elements of a crisis continuum: someone to call (the 988 Suicide and Crisis Lifeline or a local crisis line), someone to respond (mobile crisis teams or co-responders), and somewhere to go (the crisis stabilization center). Ohio Governor Mike DeWine used Dayton’s center opening to describe that same framework: the center is “the final piece” of a system that “gives community members in crisis someone to call (the Montgomery County Crisis Now Hotline), someone to come to them (Mobile Crisis Response Teams), and somewhere to go.”

The relationship between mobile crisis teams and crisis stabilization centers is central to how both work well. Mobile crisis teams resolve many calls in the field without transport — Durham HEART, independently evaluated by NBER, resolved the large majority of its calls without police backup or facility transport. King County, Washington has documented a policy guaranteeing acceptance for anyone brought by a mobile crisis team — specifically designed to address the uncertainty that previously caused teams to default to emergency rooms.

Scale and Reach

As of 2024, crisis stabilization centers were operating or under active development in more than 40 states. The expansion has accelerated since 2020, driven by dedicated state funding in Ohio ($90 million under Governor Mike DeWine), Virginia ($58 million under former Governor Glenn Youngkin’s “Right Help, Right Now” initiative), and South Carolina ($45.5 million in infrastructure grants), along with local ballot measures, federal American Rescue Plan Act (ARPA) funds, and Medicaid reimbursement infrastructure that has made ongoing operations more financially sustainable than they were a decade ago.

The programs range considerably in scale. Salt Lake City’s Huntsman Mental Health Institute facility houses 200 mental health professionals and has served approximately 10,000 patients annually since opening in March 2024. Polk County, Iowa’s center admitted more than 30 people in its first 30 days, which KCCI editorial board coverage noted “exceeded operator expectations.” Three counties in rural central Pennsylvania, Cumberland, Dauphin, and Perry, pooled resources to open a center none could have sustained independently. SAMHSA’s 2025 National Guidelines identify this same presenting need across jurisdictions: a facility for people in crisis that is neither an emergency room nor a jail.

Maricopa County has operated integrated crisis services (crisis phone line, mobile teams, and stabilization facilities) for more than 30 years. The Phoenix Crisis Response Center, operated by Connections Health Solutions since 2009, serves more than 25,000 individuals annually and remains open around the clock. Arizona’s system shaped the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care, which identified crisis stabilization as one of the essential elements of a functioning crisis continuum.

What the Evidence Shows

The independent research base for crisis stabilization centers is limited: as of 2025, one multi-state independent study and one program-affiliated study represent the strongest peer-reviewed evidence. Readers evaluating claims about effectiveness should understand what has and has not been independently studied.

The most rigorous evidence comes from a 2025 study by researchers at Indiana University’s Richard M. Fairbanks School of Public Health, funded by the Agency for Healthcare Research and Quality. Examining longitudinal data from 2016 to 2021 across 1,002 zip codes in Arizona, Florida, Kentucky, Maryland, and Wisconsin, the researchers found that availability of walk-in crisis stabilization services was associated with statistically significant reductions in mental-health-related emergency department utilization. This is an independent peer-reviewed finding across multiple states with a controlled research design.

A 2024 study by researchers from Arizona State University and Connections Health Solutions, published in a peer-reviewed psychiatric journal, examined patient flow through Arizona’s crisis system using Medicaid claims data and electronic health records. The researchers found that the majority of individuals — 57.4% — entered the Arizona crisis system through mobile crisis or crisis facilities rather than emergency departments, and that 63.3% of patients at the Tucson Crisis Response Center did not reutilize crisis or emergency services within 30 days. This study used linked claims and EHR data, which gives it more rigor than program-only self-reports, though Connections Health Solutions was a co-author with a stake in the findings.

Cost comparisons cited by program advocates and elected officials typically derive from Arizona’s Maricopa County system, where the “Arizona Crisis Now” model estimates that a $100 million investment in the full crisis continuum (phone, mobile, and facility) reduced potential state acute care inpatient expense by $260 million and avoided $37 million in hospital psychiatric boarding costs, while freeing 37 full-time-equivalent police officers for other duties. These figures are program-reported estimates, not independently audited savings — a distinction that matters when presenting them to skeptical budget officials.

The Burns et al. 2025 study provides independent peer-reviewed evidence that crisis stabilization centers reduce emergency department utilization. The Arizona State University / Connections Health Solutions study provides program-affiliated evidence on patient flow and short-term non-reutilization. Neither study addresses long-term revolving-door reduction — whether stabilization prevents the next crisis over months and years. That question has not been answered by independent research as of 2025.

Bottom Line

The Burns et al. 2025 study provides independent peer-reviewed evidence that access to crisis stabilization services is associated with statistically significant reductions in emergency department utilization for behavioral health crises. The Arizona program-reported data projects $260 million in reduced inpatient expense from a $100 million investment — a model estimate, not an independently audited result. Long-term revolving-door reduction has not been demonstrated by independent research as of 2025.