Understanding the Facilitators and Barriers to the Use of Crisis Stabilization Units As an Alternative to Arrest

Background and Purpose: Law enforcement officers frequently respond to individuals in a mental health or substance use crisis. Likewise, research indicates that many incarcerated individuals have mental health and substance use concerns. In an attempt to divert individuals with mental health and substance issues from the criminal justice system, an alternative option is becoming increasingly available to offices. Crisis Stabilization Units (CSUs) are public receiving facilities that provide short-term inpatient stabilization services. CSUs allow officers to link individuals experiencing a crisis to appropriate supportive services. While drop-off mental health centers, as a form of pre-booking diversion, have been used since the 1990s, little is understood about the factors considered by law enforcement when utilizing CSUs and the collaboration process between officers and CSU providers. This paper explores the facilitators and barriers of using CSUs as an alternative to arrest for individuals experiencing a mental health or substance use crisis.

Methods: In-depth, semi-structured interviews were conducted with 70 law enforcement officers from seven different agencies in a southern state. In-depth, semi-structured interviews were conducted with 11 CSU staff from two behavioral health centers in the same counties as the law enforcement departments. Purposive sampling was used to strategically identify officers and mental health professionals who have experience with CSUs. Interviews were transcribed and coded thematically using Nvivo qualitative software guided by the principles of phenomenological qualitative research.

Findings: Data analysis revealed that both CSU staff and officers identified barriers to communication and a conflict in expectations. For example, mental health professionals may turn away clients at CSUs due to the threat of violence, requiring officers to take individuals to jail. CSU staff perceived officers as misunderstanding CSU admission criteria leading to the release of individuals brought to the CSU by police. Officers noted that the discretion to use CSUs was influenced by department policies, such as involuntary commitment procedures, whether a crime has been committed, and the officer’s understanding of mental health. Both officers and CSU staff identified the benefit of collaboration. Officers noted the ability to take individuals to a CSU as an asset, along with the ease in the transfer of civilians to the care of CSU staff. CSU staff indicated that the assistance of officers’ presence during the admission process with patients added to the facility’s safety.

Conclusions and Implications: The findings highlight that while both parties see collaboration as a benefit, there is a need for communication and transparency of policies and procedures between law enforcement and CSU mental health staff. The current lack of understanding of policies between the agencies has led to frustration and logistical barriers between officers and CSU staff that result in the potential underutilization of resources and collaborative opportunities.