I would strongly encourage further discussion regarding the potential for 23 Hour Crisis Centers to accept individuals under an ECO or TDO, particularly when those individuals would share space with voluntary individuals.

One of the fundamental purposes of a Crisis Center is to provide a safe, calm, therapeutic environment where individuals can voluntarily seek support, de-escalate, and ideally prevent a crisis from progressing to a higher level of care. Introducing individuals who are involuntarily detained and may require a significantly higher level of supervision and intervention has the potential to change that environment.

The needs of voluntary individuals seeking support and those requiring involuntary detention can be dramatically different. We should be cautious about creating an environment in which meeting the needs of one population unintentionally compromises the therapeutic experience, sense of safety, or willingness to seek services of another. Many individuals choose Crisis Center services specifically because they offer an alternative to the acuity and environment of an emergency department or inpatient setting. If the Crisis Center begins to resemble those environments, we risk losing one of the very things that makes this level of care effective.

We see a similar principle with Crisis Stabilization Units. For some individuals, a CSU provides a more therapeutic and less overwhelming alternative to a higher-acuity inpatient environment. There are individuals who will voluntarily accept treatment in a CSU specifically because they feel safer there but would not go voluntarily to a psychiatric hospital. We should preserve that same intentionality across the crisis continuum rather than making every level of care serve every level of acuity.

There are also significant operational considerations. Our current Crisis Center infrastructure and staffing model were designed around voluntary crisis services. Managing individuals under an ECO or TDO may require different staffing, including continuous or 1:1 supervision, enhanced safety measures, and other resources that many Crisis Centers were not designed or funded to provide; not to mention that we already serve ECO’s at the CIT Assessment Center and TDO’s at the CSU at our CSRC location.    

Additionally, an ECO involves law enforcement custody. For many of the individuals we serve, the presence of law enforcement can itself be distressing or triggering. Bringing that dynamic into a space intentionally designed to feel safe, voluntary, and welcoming deserves careful consideration.

Ultimately, my concern is about protecting the integrity and purpose of Crisis Center services. Voluntary individuals should be able to access the environment we have represented to them: a safe, calm, therapeutic place to seek help before their situation escalates. We should be very cautious about implementing changes that could unintentionally discourage lower-acuity individuals from seeking help early or make them feel less safe once they arrive.