Crisis housing (or crisis residential services) are supervised short-term residential alternatives to hospitalization for adults with serious mental illnesses or children with serious emotional or behavioral disturbances.
The course of most serious mental illness (such as schizophrenia, bipolar disorder, severe depression, and borderline personality disorder) is cyclical, typically characterized by periods of relative well-being, interrupted by periods of deterioration or relapse. When relapse occurs, the individual generally exhibits florid symptoms that require immediate psychiatric attention and treatment. More often than not, relapse is caused by the individual's failure to comply with a prescribed medication regimen (not taking medication regularly, not taking the amount or dose prescribed, or not taking it all). Relapse can also be triggered during periods of great stress or can even occur spontaneously, without any marked changes in lifestyle or medication regimen. When these crises recur, the goal of treatment is to stabilize the individual as soon as possible, since research suggests that these patients are also more likely to attempt suicide.
Over the past 30 years, crisis housing programs have evolved as short-term, less costly, and less restrictive residential alternatives to hospitalization. Intended to divert individuals from emergency rooms, jails, and hospitals into community-based treatment settings, they offer intensive crisis support to individuals and their families. Services include diagnosis, assessment, and treatment (including medication stabilization); rehabilitation; and links to community-based services. These programs are intended to stabilize the individual as rapidly as possible—usually between eight and 60 days—so they can return to their home or residence in the community.
Some of the earliest crisis housing programs include Soteria House and La Posada, which began in northern California in the 1970s, and the START (short-term acute residential treatment) program that began in San Diego in 1980. While programs vary from location to location, most offer acute services 24 hours a day in a small noninstitutional residential setting. Adequate structure and supervision is provided by an interdisciplinary team of professionals and other trained workers.
Beginning the day they arrive, residents help develop their own plans for recovery and continued care in the community. Patients receive state-of-the art psychopharmacological treatment and other cognitive-behavioral interventions. Residents are encouraged to play an active role in the operation of the household, including meal preparation. The home-like environment is helpful in lessening the stigma and sense of failure that often occurs when someone needs to return to an inpatient psychiatric unit.
Similarly, in the case of seriously emotionally disturbed children and adolescents, the goal of crisis housing is to avert visits to the emergency room or hospitalization by stabilizing the individual in as normal a setting as possible. Compared to these services for adults, there is typically greater emphasis placed on involving families and schools in planning for community-based care after discharge.
While the evidence base for crisis housing is comprised primarily of uncontrolled studies, evaluations of several of these programs suggest that they may provide high-quality treatment and care at a lower cost than hospitals. Crisis housing is not currently available in all communities, however.
See also Crisis intervention
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Irene S. Levine, Ph.D.