Why Does This Exist?

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.

The Emergency Department Problem

Dr. Margaret Balfour, whose research on psychiatric emergency care is cited in the SAMHSA 2025 National Guidelines, describes emergency departments as designed around rapid medical stabilization — staffed, designed, and reimbursed for throughput on physical medical emergencies.

Dr. Balfour’s research documents that 46% of emergency departments lack psychiatric consultation services and 59% must transfer psychiatric patients elsewhere. Arizona’s AHCCCS data describes the result — psychiatric boarding — as averaging 1,089 minutes per patient in Maricopa County emergency departments.

Arizona’s AHCCCS system — cited in SAMHSA’s 2025 National Guidelines as a foundational model — quantified the cost of psychiatric boarding at the hospital level: the average length of stay in an emergency department for a psychiatric patient was 1,089 minutes. At an estimated boarding cost of $2,264 per person, hospitals in Maricopa County were absorbing $37 million in boarding costs annually before crisis stabilization alternatives were fully operational.

The individual experience matches the systemic data. A 17-year-old named Calvin Carbello described his experience at an urgent psychiatric care clinic in Phoenix to PBS NewsHour in 2024 after a crisis episode: “I got dropped off in this small little room with a bunch of other kids asleep in chairs. I was up all night and maybe slept for two hours… just waking up to kids screaming about whatever in the middle of the night. It was bad.” His mother Kelly told the same reporter that little clinical treatment occurred during the stay. PBS NewsHour noted that Phoenix is a city with significant crisis infrastructure; the Carbello account illustrates that facility-level quality is not guaranteed by system-level investment.

The frustration runs in both directions. A 2024 survey by the American College of Emergency Physicians of 32,000 physicians, residents, and medical students found that 8 in 10 emergency department doctors said the mental health system is not working for patients. Atlanta Police Chief Darin Schierbaum reported that his department responded to more than 9,000 mental health crisis calls in 2021, adding: “That is not the role of the court… when you look at the limited resources that an Atlanta police officer carries, you see our frustration.”

The Jail Problem

The other default destination for people in mental health or substance use crisis is the criminal justice system. The National Alliance on Mental Illness reports that about two in five people who are incarcerated have a history of mental illness. Of those, three in five do not receive mental health treatment while incarcerated. The Treatment Advocacy Center documents that jails have become the default behavioral health facility in many counties — not because they are designed for that function, but because they are the only 24-hour facility that must accept anyone brought to them.

Fulton County Superior Court Judge Robert C. McBurney described the consequences plainly at the ribbon cutting for Atlanta’s first behavioral health crisis center in 2024: “We are going to create opportunities that we haven’t had before so that people in a mental health crisis have an option other than going to our jail and dealing with me. I am not the counselor that these folks need to see.”

The Vera Institute of Justice has documented that incarceration creates barriers to housing, employment, and public benefits — barriers that make it harder, not easier, to access behavioral health care after release.

The Revolving Door

Travis County Judge Andy Brown told the Texas Tribune that in Miami, the city saved $4 million annually after people arrested with mental illness were routed to crisis centers instead of jail. In Nashville, 80% of people who received care at a crisis stabilization center did not return to jail — program-reported figures from specific jurisdictions. Guilford County, North Carolina documented one targeted intervention that reduced a single individual’s 911 calls from 344 in a month to 4. Dr. Balfour’s research describes the emergency department’s function as stabilizing the acute episode and discharging — not treating the underlying condition. Crisis stabilization centers, by design, include discharge planning and connection to ongoing care as core functions.

The Workforce Misalignment

The third dimension of the problem is the workforce responding to behavioral health crises in the absence of specialized facilities. SAMHSA’s documentation on law enforcement and crisis response notes that mental health crisis intervention represents a small fraction of standard police academy training time relative to firearms, defensive tactics, and legal procedures — a pattern documented across multiple state academy curriculum reviews.

San Angelo, Texas Police Director’s office cited law enforcement bringing approximately 50 people a month to either jail or the emergency room before a local crisis center opened; after the center opened, “law enforcement has really started to buy into this, that there’s another route to change,” according to Steven Garlock, director of the West Texas Mental Health Center.

Atlanta Police Chief Schierbaum reported over 9,000 mental health calls in 2021 — calls handled by officers whose training, as Chief Schierbaum described it, does not match what the situations require.

Why It Exists Now

The SAMHSA 2025 National Guidelines identify ARPA construction funding and the 988 Lifeline relaunch as the conditions that enabled the 2022–2025 build period.

Federal stimulus funding through the American Rescue Plan Act (ARPA) from 2021 through 2024 provided a capital infusion that allowed cities and counties to fund facility construction without waiting for the long budget cycles that typically govern mental health infrastructure. Ohio’s $90 million state investment, Virginia’s $58 million commitment, and South Carolina’s $45.5 million in infrastructure grants all drew substantially on ARPA capital — a funding source that expired in 2024. Programs that did not establish durable operating revenue during the construction window face sustainability risk.

States including Ohio, Virginia, Georgia, and South Carolina made crisis stabilization a legislative priority with specific appropriations, providing the operating infrastructure that ARPA construction dollars alone could not sustain. The 988 Suicide and Crisis Lifeline, relaunched in 2022, fielded nearly 5 million contacts in its first year of operation, according to SAMHSA. The SAMHSA 2025 National Guidelines identify crisis stabilization facilities as the “somewhere to go” that completes the crisis continuum the 988 line activates.

As of 2024, crisis stabilization programs operate or are under development in more than 40 states, according to SAMHSA.

Bottom Line

Dr. Balfour documents 46% of EDs lacking psychiatric consultation. NAMI documents two in five incarcerated people having mental illness, three in five receiving no treatment. The SAMHSA 2025 guidelines identify ARPA construction funding and the 988 relaunch as the conditions that enabled the 2022–2025 build period.