Behavioral health emergency department visits across the U.S. are projected to increase by 1 million over the next decade. In response to rising demand, Philadelphia-based Penn Medicine opened a crisis response center in 2023 at Hospital of the University of Pennsylvania-Cedar Avenue and has seen measurable results.
Six months before the center opened, the Cedar Avenue ED was averaging 297 psychiatric consults per month. In the first six months after the crisis response center, or CRC, launched, that figure dropped to 56 per month, a more than 80% decrease. The number of patients who needed to receive psychiatric care in the ED as opposed to being able to receive it in a space built for psychiatric care has stayed at or below 56 per month since, said Katie Dalke, MD, the system’s vice chair for clinical Operations in psychiatry.
When Penn Medicine entered into an agreement to deliver behavioral health services on the campus in March 2021, there was no psychiatric emergency room on site, only a medical ED, a detox unit and two inpatient units. Patients experiencing mental health crises were coming through the medical ED and then being transported by ambulance across the city to Pennsylvania Hospital, which had its own CRC, before potentially being sent back to Cedar Avenue for detox or inpatient care.
“That’s a lot of transitions for people who are in crisis,” Patty Inacker, vice president of behavioral health for Penn Medicine, told Becker’s.
A crisis walk-in center had previously operated on the Cedar Avenue campus before Penn Medicine took over, and neighborhood residents and city officials advocated for its reopening. The city of Philadelphia made a financial investment to support it, and Penn Medicine ultimately opened the walk-in facility on the other side of the building from the medical ED, with its own entrance.
Still, challenges arose.
“The community continued to go to the emergency room, because that’s what they knew,” Ms. Inacker said. That reality shaped much of what followed: a yearslong effort to route patients arriving at any door to the right level of care.
The Cedar Avenue campus now has three separate access points for emergency care: the CRC for psychiatric care, a medical ED and a Children’s Hospital of Philadelphia crisis center for patients younger than 18. Stephanie Hollister, MSN, RN, assistant vice president of behavioral health for the Cedar Avenue CRC, said roughly 200 patients are still using the medical ED entrance and being redirected. Leaders from the CRC and the ED meet monthly to review throughput, reduce length of stay in the ED and work through what can be done differently.
The model
The CRC target is a maximum six-hour stay, from triage by a nurse through clinician interview and provider assessment to disposition. That benchmark is achievable when patients are moving to inpatient units on the same campus or to Pennsylvania Hospital, Ms. Hollister said. It becomes harder at night, when transport logistics are complicated and discharges are not happening until morning.
“The crisis response center really only serves people truthfully that need an acute inpatient stay. Everyone else gets a referral to outpatient,” Ms. Inacker said. “We don’t start treatment in a crisis response center in Philadelphia. … It’s not within the license.”
The cross-campus coordination has been central to the model. Patients can move between Cedar Avenue and Pennsylvania Hospital for psychiatric inpatient care and detox services within the Penn Medicine network, rather than cycling repeatedly through a single emergency department.
Lessons learned
The CRC has separate voluntary and involuntary entrances positioned side by side. The goal was visibility, so staff could see who was arriving and manage patient flow. In practice, Ms. Hollister said, the distinction has required ongoing adjustment. Staff are now accustomed to directing patients arriving with police to the designated entrance, sometimes asking them to move over “a couple of feet” to the correct door. She said a single entrance could be considered in future designs.
The center also serves a patient mix that has grown more complex. Where psychiatric patients once arrived with relatively straightforward diagnoses, they now frequently present with hypertension, diabetes and other comorbidities that complicate where and how they should be treated.
Both Ms. Hollister and Ms. Inacker described a fast track as something the team would like to implement, similar to how emergency departments triage by acuity, to move patients more quickly to the right care within the CRC itself.
The economics
Ms. Inacker was direct about the financial reality.
“I know that with the state of Medicaid these days, we may be seeing a lot more people who can’t afford to pay or don’t have the resources or don’t have the right insurance, but we have to do it anyway,” she said.
Integrated behavioral health, she argued, requires partners outside psychiatry to accept that revenue and cost cannot be the primary drivers.
“It has to be a patient-centered care decision, and that’s hard because the economics play into this,” Ms. Inacker said.
The referral gap is one of the persistent issues the model has not solved. Patients leaving the CRC with a referral to outpatient care face wait times that can stretch months. In light of this, Ms. Inacker raised the question: Are patients returning to the crisis center because they cannot access care anywhere else?
“We’re giving somebody a phone number to say, ‘Hey, call or reconnect with your outpatient, and that’ll be X number of months from now,'” she said. “‘X number of months from now, do I still have the same issue? Is it worse? Have I returned to the crisis response center because I can’t get care?’ That’s the issue I would look at.”
What other systems should know
For health system leaders considering a crisis response center, Ms. Inacker’s core recommendation is to embed it within services that already exist. She argued that integrated, embedded models both support comprehensive care and help reduce the stigma that still surrounds psychiatric treatment.
Ms. Hollister emphasized community education as an underestimated variable.
“Before I started in behavioral health, I didn’t know what a crisis response center was,” she said. “People don’t know, and automatically with something like anxiety or depression, I would normally go to the ER. I would not know to go to a crisis response center for that.”
Philadelphia has five psychiatric emergency rooms; Inacker called that number insufficient for the community’s needs.
The CRC at Cedar Avenue is designed to feel different from a medical ED: ligature-free rooms, no cellphones, a locked door and staff trained in de-escalation. Ms. Hollister noted that the experience of arriving at a crisis center is meaningfully different from a standard ED visit, where a patient gives their name, sits in a waiting area and waits to be called back.
“You go in, you give up your belongings, you go behind a locked door, and you have to have a doctor even tell you if you can leave or not if you change your mind,” Ms. Hollister said. “Completely different, but also more supportive of safety.”
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