23-hour crisis relief centers
23-hour crisis relief centers (CRCs) provide low-barrier behavioral healthcare for urgent and emergent needs. These facilities provide an alternative to unnecessary emergency room visits and reduce interactions with law enforcement for people experiencing a mental health crisis.
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About CRCs
CRCs are designed to be a no-wrong door, no barrier method to access crisis stabilization services. These facilities are a brief landing place that use multidisciplinary teams to address immediate needs and connect individuals to the appropriate next steps in their care plan. These plans are developed in cooperation between the individual and CRC staff. Depending on the individual’s needs, next steps might include anything from short-term case management to intensive outpatient therapy to inpatient care.
CRCs are not designed for stays of more than 23 hours and 59 minutes, so they are not classified as residential treatment facilities. However, special exceptions, such as waiting for an evaluation by a designated crisis responder (DCR) or waiting to transition to another setting as a part of their care plan, may allow an individual to stay at the facility for up to 36 hours.
If an individual is benefiting from crisis stabilization services and would benefit from additional time with crisis services, they may be transferred from the CRC to a crisis stabilization unit.
CRCs are certified using the requirements in WAC 246-341-0903.
FAQs
- Who do 23-hour crisis relief centers serve?
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CRCs serve individuals who self-report experiencing a behavioral health crisis. The only exception to this is individuals who are on an involuntary hold for an Involuntary Treatment Act (ITA) assessment by a designated crisis responder (DCR).
It is important to highlight that individuals do not have to be medically cleared to begin an intake at a CRC. CRCs’ multidisciplinary teams include medical staff that can support people who need minor wound care or have basic medical needs. The medical staff will determine if an individual has medical needs beyond the capabilities of the CRC, and CRC staff will help the individual obtain a higher level of medical care, including necessary transportation.
CRCs have a target of accepting at least 90 percent of referrals, and all refused referrals are well-documented and tracked for quality assurance purposes. Additionally, CRCs have a no-refusal policy for individuals referred by law enforcement, even when accepting the referral would cause the facility to exceed capacity.
CRCs can currently only serve adults, but rule making for youth facilities is in progress.
- What are the requirements for a CRC?
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- 23-hour crisis relief centers must be staffed 24/7 and able to provide assessments for psychiatric medication, medication management and administration, substance use and withdrawal services, peer counseling, and care coordination.
- Facilities also need to be equipped to provide minor wound care and support people with low-intensity health needs.
- CRCs may not refuse law enforcement referrals, even if the referral causes the facility to exceed capacity.
- CRCs may only refuse law enforcement referrals when the individual’s health needs require more intensive services than the facility is able to provide itself.
- CRCs may be standalone facilities, or part of a broader campus of care model that can include crisis stabilization units (CSUs) and ongoing services.
The general structure for CRCs is outlined in RCW 71.24.916 with the licensure requirements listed in WAC 246-341-0903.
- Who can make a referral to a CRC?
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- People may be referred by law enforcement, fire/EMT, mobile crisis teams, or 988.
- If an individual feels they are in crisis, they can go straight to a CRC for an intake or they can have a friend or family member bring them.
- Hospitals can only refer individuals to CRCs if they have a pre-arranged agreement. Most commonly, these prearrangements occur when an individual initially presents at a CRC but requires a higher level of care.
- Once the individual is stabilized, the hospital and CRC can agree to have the individual return to the CRC in order to resume the crisis services that were delayed due to medical necessity.
- What services are provided at CRCs?
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Depending on the need, individuals may receive services such as:
- Crisis intervention
- Psychiatric medication assessments
- Medication management or administration
- Peer support
- Care coordination
- Substance use disorder support
- Physical health services
- Connection to social services
Background
In 2020, SAMHSA released their vision of an ideal crisis system continuum. This continuum contains three elements:
- Someone to contact
- Someone to respond
- A safe place for help
Crisis stabilization facilities are part of the safe place for help. Crisis stabilization is not an entirely new concept in Washington. Individuals needing crisis care have historically been able to access outpatient crisis stabilization services, certified under WAC 246-341-0901, and crisis stabilization units, certified under WAC 246-341-1140.
The 2023 legislative session expanded those options by introducing 23-hour crisis relief centers now outlined in RCW 71.24.916. The crisis relief center model is based on similar models in Arizona and New York, as well as SAMHSA's Best Practice Guidelines.
The Department of Health (DOH) published WAC 246-341-0903 in 2024 which establishes licensure requirements for 23-hour crisis relief centers.