Creating Buy-In: Best Practices for Collaborating with Referral Sources for Crisis Stabilization Units

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Crisis stabilization units offer law enforcement officers and mobile crisis teams a safe place to bring people in behavioral health crisis, often in lieu of arrest or emergency hospitalization. However, they can be challenging to establish without the appropriate funding and support from key partners needed to operate the units effectively. Creating buy-in among referral sources, is one important component of achieving this support needed. This brief offers crisis stabilization unit leaders three best practices for collaborating with referral sources to ensure its success. Photo by camilo jimenez on Unsplash

Marilyn Leake | November 2021 | The Council of State Governments Justice Center

Crisis stabilization units (CSUs) provide law enforcement officers and mobile crisis teams a safe place to bring individuals in behavioral health crisis, oftentimes in lieu of arrest or emergency hospitalization.¹

Licensing and regulatory requirements differ by state, but in general, CSUs provide immediate access to care for people in crisis and connect them to the most appropriate supportive services for ongoing care in the community. However, establishing a CSU can be challenging without the appropriate amount of funding and support from key partners necessary to ensure that the units operate effectively. Buy-in from referral sources, particularly law enforcement agencies, is crucial to ensuring that people are appropriately connected to the CSU and that the services provided meet local needs. This brief distills information from a webinar hosted by The Council of State Governments (CSG) Justice Center in partnership with the National Police Foundation and offers CSU leaders three best practices for collaborating with referral sources to ensure its success.

We have to have buy-in from everybody… to get the everyday line officer involved, not just those who self-select into the collaborative positions.

Lt. Shawn Hill

Santa Barbara Police Department

1. Understand the Landscape of Local Referral Sources.

CSUs can receive referrals from several sources depending on the structure of the center and the services provided. Identifying referral sources and building formal structures for these referrals is a key step in establishing effective policies and procedures for a CSU. Common referral sources include:

Co-responder, mobile crisis, or community responder teams
Crisis lines, 988, 911
Hospitals (particularly emergency departments)

Other health care providers (community mental health clinics, primary care, etc.)
Local law enforcement
Jails

Other criminal justice partners, such as probation departments
Peer support specialists
Walk-ins²

A systems mapping exercise can be used to assess the community’s crisis services needs and understand the resources already being utilized and overutilized in a jurisdiction. This information can help CSU leaders determine the services that should be prioritized and who the likely referral sources may be.

2. Foster Effective Partnerships with Referral Sources.

Once CSU leaders determine who their likely referral sources will be, they will need to establish formal partnerships to encourage continued support for the CSU. One important way to do this is outlining clear communication pathways, procedures, and responsibilities, usually with a memorandum of understanding³ that details each agency’s role with the CSU. Leaders may also want to consider a data sharing agreement or data sharing system to formalize information sharing among referral sources and partners; these will both need to be developed in accordance with federal and state privacy regulations. Additionally, involving referral sources in planning conversations regarding key decisions such as center location, services provided, and target population can help create a groundswell of support for the CSU and realistic expectations among system partners. Regularly scheduled weekly or monthly meetings with partners can then offer opportunities to receive ongoing feedback from referral sources on daily operations and where improvements are needed.

Many CSUs will leverage existing steering committees or create an advisory board to ensure that local leaders are able to provide oversight and have a forum for collaboration. Including key referral sources in these committees or advisory boards can engender support for the CSU and encourage ongoing engagement and participation in the activities and management of the CSU.⁴

3. Be Flexible to Meet Referral Sources’ Needs.

Ensuring that the CSU is responsive to local needs and easy to access is critical in garnering support from referral sources. During the webinar, representatives from some of the most common referral sources spoke about ways to ensure the CSU meets their needs and is convenient and easy to access. Below are some examples that they offered:

Accept both walk-ins and referrals.
Allow for referrals of people who may remain in police custody.
Accept all law enforcement referrals, including people who are acutely agitated or intoxicated.

Ensure the CSU is in a convenient location with a quick drop-off process for law enforcement.
Offer multiple types and levels of services, including services for mental health and substance use disorders.

Provide diversion options for both hospitals and law enforcement.

To ensure referral resources needs are being met, CSU leaders should seek to not only include referral sources in the initial planning process, but also make sure that they are involved in all ongoing developments, particularly evaluations. Giving referral sources regular opportunities to evaluate the effectiveness of the CSU will help leaders better understand the needs of each referral source and respond to those needs in a timely fashion.

Additional Resources

Building a Comprehensive and Coordinated Crisis System

A Matter of Public Health and Safety: How States Can Support Local Crisis Systems

Advancing the Work of Peer Support Specialists in Behavioral Health-Criminal Justice Programming

Police and Mental Health Collaboration Toolkit

Roadmap to the Ideal Crisis System: Essential Elements, Best Practices, and Measurable Standards for Behavioral Health Crisis Response

Footnotes

^1. CSUs are sometimes known as crisis centers, law-enforcement receiving centers, 23-hour observation units, Emergency Treatment Assessment and Healing (EmPATH) units, psychiatric emergency services (PES) units, or diversion/deflection centers. Ideally, officers will bring someone to the CSU in lieu of arrest. However, there are instances when an arrest is still necessary, but the officer will opt to use the CSU to stabilize the person before they are sent to jail. In these situations, the CSU serves as an opportunity for the person to receive appropriate behavioral health care prior to jail intake that can hopefully continue once the person is in custody. See Demetrius Thomas, Tips for Successfully Implementing Crisis Stabilization Units (New York: CSG Justice Center, 2021), https://csgjusticecenter.org/publications/tips-for-successfully-implementing-crisis-stabilization-units/.

^2. Walk-ins (or self-referrals) are often an important component to consider when creating CSU policies and procedures and determining ways to make it easier for people to access the center.

^3. For examples of memoranda of understanding, see the “Stepping Up Strategy Lab: Partnership Agreements,” CSG Justice Center, accessed September 20, 2021, https://lab.stepuptogether.org/database/entry/partnership-agreements/; “Sharing Behavioral Health Information within in Police-Mental Health Collaborations: Establishing an Information Sharing Approach,” CSG Justice Center, accessed September 20, 2021, https://csgjusticecenter.org/projects/police-mental-health-collaboration-pmhc/sharing-behavioral-health-information/forming-strong-collaborations/.

^4. CSU leaders should also involve groups such as the National Alliance on Mental Illness, local advocacy groups, recovery courts, community members, and community behavioral health or other service providers to ensure to build consensus in the community and ensure all points of view are considered.

Project credits

Writing: Marilyn Leake, CSG Justice Center

Research: Marilyn Leake, CSG Justice Center

Advising: Dr. Allison Upton and Demetrius Thomas, CSG Justice Center, and National Police Foundation

Editing: Darby Baham, CSG Justice Center

Design: Michael Bierman

Public Affairs: Ruvi Lopez, CSG Justice Center

Web Development: Eleventy Group

Partner: National Police Foundation

This project was supported by Grant No.2019-MO-BX-K001 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Department of Justice’s Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.

About the Author

Marilyn Leake

Project Manager, Behavioral Health

Marilyn Leake works on county-based initiatives focused on improving outcomes for people in the criminal justice system who have behavioral health disorders. Prior to joining the CSG Justice Center, Marilyn served as the coordinator for the mental health and drug

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court programs in Prince George’s County, Maryland. In that role, she collaborated closely with local stakeholders throughout the criminal justice and behavioral health systems on diversion and other tactics to improve outcomes for people in the justice system with behavioral health disorders. She also worked on initiatives to standardize data collection and measurement strategies for treatment courts in Maryland. Marilyn holds a BS from Appalachian State University and an MSW from the University of Maryland.