Behavioral health leaders across the country are confronting a patient population that looks nothing like it did a decade ago: Emergency departments are seeing longer boarding times, inpatient units are treating more complex psychiatric and medical needs at once, and staff are being asked to manage crises that once would have been rare.
Becker’s asked behavioral health executives from hospitals and health systems around the country how they’re redesigning care to meet rising acuity, and which project is making the biggest difference. Their answers point to a common thread: no one solution works in isolation.
Leaders described building connected systems of care that stretch beyond hospital walls, investing heavily in workforce training and simulation, standardizing pathways for telepsychiatry and assessment, creating specialized crisis response teams, and rethinking the handoff between law enforcement, EDs and inpatient units.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How are you redesigning behavioral healthcare to manage patients with higher acuity, and what’s one project that’s making the biggest difference?
Laura Buckley. COO of Connections Health Solutions (Phoenix): What some people may not know is that Connections was founded by two emergency room psychiatrists, who would see individuals experiencing a behavioral health crisis wait for hours — sometimes even days — in the ER for an inpatient bed. These individuals were highly acute and needed focused, intensive care and treatment immediately.
Connections’ centers were designed to treat high-acuity individuals, and our outcomes show that this model works. 68% of individuals are stabilized in 23 hours and discharged back to the community – avoiding an ER visit and inpatient stay; 70% have a follow-up appointment scheduled once they leave our care; and less than 4% of individuals treated at Connections readmit to a higher level of care within 30 days. Who we serve has not changed since Connections was founded. What is evolving is demand for crisis services, and how we are leveraging technology to extend our expertise and increase our impact. We’re giving our care teams tools that reduce administrative work so they can spend more time with patients. One project making a significant impact is our investment in technology that helps our providers work at the top of their licenses.
By streamlining documentation, we’re enabling our providers to fully focus on the patient in front of them, providing personalized care and working with our multidisciplinary team to coordinate the right supports at the right time. At Connections, technology will never replace the human connection; instead, we are finding ways to strengthen it. By freeing our teams to focus on what matters most, Connections is helping patients address their crisis more quickly, return to their lives, and access post-crisis care so that they are less likely to need readmission.
Dominique Dietz. Director of Virtual Behavioral Health for OSF HealthCare (Peoria, Ill.): As a social worker, I’ve always believed that high-quality behavioral healthcare starts with meeting patients where they are, especially during their most vulnerable moments. At OSF HealthCare, our focus has been on expanding and standardizing acute behavioral health services across the system to improve access, quality, and outcomes for patients with the highest behavioral health needs.
Over the past three years, we’ve successfully implemented an on-demand telepsychiatry model across our emergency departments and medical inpatient units. This has significantly improved access to psychiatric consultation, reduced delays in care, and allowed patients in both rural and urban communities to receive timely behavioral health evaluations regardless of local psychiatrist availability.
Today, we’re taking that work a step further through a system-wide redesign of our acute behavioral health model. Rather than viewing telepsychiatry as simply a consultation service, we’re building a standardized care pathway that supports the entire patient journey. Our multidisciplinary team is defining consistent workflows for behavioral health assessments, discharge and referral planning, admission documentation, and clear escalation criteria for when psychiatric intervention is needed.
The goal is twofold: ensure every patient receives equitable, high-quality behavioral healthcare no matter where they enter our system, while also being thoughtful stewards of our limited psychiatric resources. By standardizing processes and ensuring each team member is practicing at the top of their license, we’re allowing psychiatrists to focus their expertise on the patients who need it most while improving throughput, reducing variation in our facilities and strengthening transitions of care.
For me, this project represents the intersection of clinical excellence and compassionate care. It’s not just about redesigning workflows, it’s about creating a behavioral health system that is more responsive, more consistent and ultimately better equipped to serve our most at-risk patients when they need us most.
Brittany Evans, DNP. Assistant Vice President of Patient Services of Psychiatry for Cincinnati Children’s (Ohio): As the acuity of children and adolescents requiring inpatient psychiatric care continues to increase, we’ve recognized that redesigning behavioral healthcare isn’t just about adding beds or expanding services — it’s about fundamentally changing how we prepare and support the workforce providing that care. Our most significant initiative has been the redesign of our entire workforce development model, from orientation and onboarding through ongoing professional development, with a focus on competency-based learning and experiential practice. Rather than relying primarily on traditional classroom education, we’re building individualized learning pathways that allow staff to develop the knowledge, technical skills, clinical judgment, and confidence required to care for increasingly complex patients.
A cornerstone of this work is the launch of our Behavioral Health Immersive Learning Lab, which combines simulation, virtual reality, standardized patients, and interdisciplinary scenario-based training to create psychologically safe opportunities for deliberate practice. Staff can rehearse high-risk, low-frequency events, strengthen de-escalation and therapeutic communication skills, and receive structured feedback before encountering similar situations in clinical practice. The goal extends well beyond reducing workplace injuries or improving crisis response. We are intentionally building a workforce that is more competent, more confident, and better equipped to establish therapeutic relationships with children and adolescents experiencing severe psychiatric illness.
When clinicians feel prepared, they are more likely to remain regulated during moments of crisis, make sound clinical decisions, and deliver care that is both safer and more compassionate. Ultimately, caring for higher-acuity behavioral health populations requires the same level of investment in workforce capability that we expect in any other high-risk healthcare specialty. By treating workforce development as a strategic priority rather than a time-limited educational event, we’re creating a more resilient care model that benefits our staff, our patients, and their families.
Jennifer Karzenstein, PhD. Director of Psychology, Neuropsychology and Social Work; Co-Director for the Behavioral Health Center for Johns Hopkins All Children’s Hospital (St. Petersburg, Fla.): At Johns Hopkins All Children’s Hospital, we recognized that redesigning behavioral healthcare was not about creating a single program, it was about building a connected system of care. As a freestanding children’s hospital without an inpatient psychiatric unit, we understood that we had to think beyond our walls and ensure children with the highest behavioral health needs could seamlessly access the appropriate level of care.
This required strong partnerships with community mental health agencies, inpatient psychiatric facilities, schools, primary care providers, crisis stabilization programs, law enforcement, and mobile response teams. No single organization could meet the needs of these patients alone. Internally, we expanded and integrated psychology, psychiatry, neuropsychology, and social work across inpatient, ambulatory, and emergency settings while standardizing workflows that supported timely assessment, intervention, and disposition planning. Externally, our collaborative relationships bridged gaps in care, reduced unnecessary delays, and improved transitions across the behavioral health continuum.
Dorinda Mueller, RN. CEO of Alisa Ridge Behavioral Health (Aliso Viejo, Calif.): We have had to launch staff-led task force groups to strategize on pivoting our approach to managing higher acuity patients. We are a 119-bed freestanding acute psychiatric facility with both youth and adult units. This demographic allows for unique programming and adjustments to be made to support those needs.
As a result of the increase in acuity with patients, we have launched an emergency response code, the Code BERT. This Behavioral Emergency Response Team (BERT) is a critical patient‑safety resource designed to support staff and patients during moments of behavioral crisis. This specially trained staff role supports an approach grounded in trauma‑informed care.
This trauma-informed approach to managing early signs of escalation in patients aims to: create a safe, supportive environment during escalating situations, minimize re‑traumatization and prevent exacerbation of mental health symptoms, provide skilled de‑escalation support and intervention, prevent the use of restraints and seclusion whenever possible, assist with seclusion or restraint only when absolutely necessary, prioritizing de‑escalation at every step. Most importantly, this approach upholds patient dignity and reinforces a compassionate, trauma‑informed approach to care.
In order to launch this approach, we have trained a mix of various multidisciplinary team members and assigned a compliment of staff for each and every shift in the hospital. This team responds to all units similarly to a Code Blue or Cardiac Emergency Code in a General Acute Care Hospital. This specialized team will quickly assess the situation and strategize the least invasive approach to de-escalating the situation. Each shift includes a Code BERT Team with one therapist, one adjunct therapist, two nurses, and one mental health worker. This team also utilizes a Code BERT box with various patient regulation tools that include aromatherapy, stress balls, stimulation combs and pop-its.
We launched this new model of care a month ago and have drastically reduced events leading to staff further intervention with patients. We will also be launching RAID programming (Reinforce Appropriate, Implode Disruptive), a positive behavioral approach to manage and prevent severe challenging behavior with our adolescent patients in the fall of 2026. This again illustrates that the best approach to supporting the psychiatric setting is to remain fluid and adopt new approaches and models to care as an effort to provide treatment to an ever-evolving population.
R. John Repique, DNP, RN. Director of Behavioral Health Services for Augusta Health (Fishersville, Va.): Healthcare organizations are increasingly caring for behavioral health patients with higher acuity, longer lengths of stay, and more complex medical, psychiatric, and social needs. At Augusta Health, one of our most impactful initiatives has been redesigning how care is delivered in our emergency department through a combination of right-sized clinical staffing and stronger community partnerships.
We have a preferred behavioral health treatment area within our emergency department — the Purple Hallway — to better meet the needs of patients experiencing behavioral health crises. Rather than relying solely on traditional ED staffing models, we intentionally staffed this area with emergency nurses who also have experience and expertise in psychiatric nursing. This approach has improved our ability to provide trauma-informed care, de-escalate crises, identify emerging psychiatric symptoms, and engage patients more effectively during what is often one of the most vulnerable moments of their lives.
Equally important has been our work with local law enforcement agencies to streamline the handoff process for patients arriving under Emergency Custody Orders or Temporary Detention Orders. Historically, transitions between law enforcement and hospital security, then to clinical staff could be variable and operationally challenging. By partnering closely with our law enforcement colleagues, we developed a standardized handoff process that improves communication, clarifies roles, and allows officers to safely return to their communities more quickly while ensuring patients receive timely clinical assessment and treatment.
What has made the biggest difference is viewing behavioral health crisis care as a system — not simply an emergency department challenge. By aligning staffing expertise, care processes, and community partnerships, we have improved patient flow, strengthened safety, enhanced the patient experience, and created a more therapeutic environment for individuals experiencing behavioral health emergencies.
The future of behavioral health care will require this type of collaborative redesign, where healthcare organizations and community partners work together to build systems that are responsive to the growing complexity and acuity of the patients we serve.
Becky Stoll. Executive Vice President of Crisis Services for Centerstone (Nashville, Tenn.): At Centerstone, a pilot project we are now constructing involves an increased focus on the period after an individual has contact within our crisis services continuum. We know during the period immediately after someone experiences a mental health or substance use crisis episode, it can be very challenging to navigate systems of care given the neurobiological impact to the brain. Without some assistance, patients might have difficulties securing the resources they need whether social determinants of health related or mental health and/or substance use care.
To find a solution, we can look at the physical health care industry and how they address assisting patients in navigating an often-complex system. Think of those who are newly diagnosed with a medical condition and how they often are immediately assigned to someone to help them navigate what is ahead. In our pilot, we hypothesize having someone working alongside the patient and their support system, for as long as needed, will result in more connections and follow through with identified resources and increase revenue. The role of Crisis Navigator will be paramount in getting patients, who desire care, to go beyond receiving only one or two appointments and get fully engaged in mental health and substance use services. The hope is this will prevent individuals from having more crisis episodes and assist them in living lives they find meaningful and fulfilling.
Tobias Wasser, MD. Chair of Psychiatry and Behavioral Health – Fairfield Region for Hartford Healthcare (Conn.): Hartford Healthcare is engaged in several simultaneous efforts to address escalating acuity in our clinical environments. Our system has developed a system-wide workplace violence committee examining best practices and reviewing videos of acute events from across the system to identify opportunities and lessons we can cascade across the service line.
We have also redoubled our efforts to train all staff in crisis management and physical intervention protocols using advanced simulation training techniques, representing a partnership between nursing and public safety leadership. This has been piloted in certain portions of our system with plans to disseminate more broadly. Finally, we are re-examining our safety training protocols to ensure that all staff are provided the right level of training for their role and that we elevate the level of training to those working in more high acuity settings.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.