Building the Behavioral Health Crisis Care Workforce
In the past 5 years, significant federal, state, and local efforts have focused on building behavioral health crisis response services and on shifting this responsibility away from law enforcement. However, these efforts have been hampered by limitations of the behavioral health workforce. Strategies are needed to expand the workforce and to ensure that crisis responders have the competencies and skills necessary to meet the needs of the individuals they serve. Existing federal, state, and local mechanisms can be leveraged to support the development of this workforce. This effort includes investing in crisis response workforce development and training, supporting the development of a community behavioral health crisis responder credential, partnering with community colleges to expand the workforce pipeline, and establishing regional centers of excellence for training. It also includes developing strategies to ensure adequate and sustainable funding.
Amy C. Watson, Ph.D.,Kellan McNally, M.S.W., M.A.,Leah G. Pope, Ph.D., Michael T. Compton, M.D., M.P.H. Building the Behavioral Health Crisis Response Workforce, Psychiatric Services, (2026) https://doi.org/10.1176/appi.ps.20250435
From Womb to Neighborhood: A Racial Analysis of Social Determinants of Psychosis in the United States
The authors offer a hypothesized model linking structural racism with psychosis risk through interwoven intermediary factors based on existing theoretical models and a review of the literature. Neighborhood factors, cumulative trauma and stress, and prenatal and perinatal complications were three key areas selected for review because they reflect social and environmental conditions that may affect psychosis risk through a common pathway shaped by structural racism.
Anglin, D. M., Ereshefsky, S., Klaunig, M. J., Bridgwater, M. A., Niendam, T. A., Ellman, L. M., … van der Ven, E. (2021). From Womb to Neighborhood: A Racial Analysis of Social Determinants of Psychosis in the United States. American Journal of Psychiatry, 178(7), 599–610. https://doi.org/10.1176/appi.ajp.2020.20071091
Racism and Social Determinants of Psychosis
Structural racism is a fundamental cause of inequity within interconnected institutions and the social environments in which we live and develop. This review illustrates how these ethnoracial inequities impact risk for the extended psychosis phenotype.
Anglin D. M. (2023). Racism and Social Determinants of Psychosis. Annual review of clinical psychology, 19, 277–302. https://doi.org/10.1146/annurev-clinpsy-080921-074730
Beyond Face Value: Evidence for the Universality of Bodily Expressions of Emotion
The present research provides the first evidence that static, fully visible bodily expressions of anger, sadness, and(to a lesser extent) fear are reliably recognized by members of an isolated small-scale traditional society, supporting the universality of these displays.
Witkower, Z., Hill, A. K., Koster, J., & Tracy, J. L. (2021). Beyond Face Value: Evidence for the Universality of Bodily Expressions of Emotion. Affective science, 2(3), 221–229. https://doi.org/10.1007/s42761-021-00052-y
Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education
Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial, non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations.
Tervalon, M., & Murray-García, J. (1998). Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125. https://doi.org/10.1353/hpu.2010.0233
Integrated Assessment Guidelines
Although there is no single gold standard assessment tool for co-occurring disorders, there are certain guidelines you can use when doing an integrated assessment.
A Welcoming Space to Manage Crisis: The Wellness Respite Program
When a person experiences severe emotional distress, crisis alternatives are a viable option instead of inpatient hospitalization to address the distress and restore balance. Peer respite programs are voluntary, short-term, crisis alternatives for people experiencing mental distress. Models have evolved in response to funding and regulatory requirements, yet research is limited. The current article describes a unique peer-led program, Wellness Respite, in operation for 7 years, including data from recent satisfaction surveys and the role of nurses in the program. Implications of a home-like, short-term crisis alternative and the role of the nurse are emphasized.
M. Swarbrick, 2022 A Welcoming Space to Manage Crisis: The Wellness Respite Program
The Accountable Health Communities Health-Related Social Needs Screening Tool, Center for Medicare and Medicaid Services (CMS), 2025
Growing evidence shows that if we deal with unmet Health Related Social Needs (HRSN) like homelessness, hunger, and exposure to violence, we can help undo their harm to health. Just like with clinical assessment tools, providers can use the results from the HRSN Screening Tool to inform patients’ treatment plans and make referrals to community services.
Risk Assessment in Clinical Practice: A Framework for Decision-Making in Real-World Complex Systems
Risk assessment in clinical practice is often characterized as a process of analyzing information so as to make a judgement about the likelihood of harmful behavior occurring in the future. However, this characterization is brought into question when the evidence does not support the current use of risk assessment approaches to predict, or provide probability estimates of, future behavior in a way that is usable in single instances arising in individual cases. This article sets out a broader and more clinically applicable description of risk assessment which takes account of the wider influences on how this clinical activity takes place. In so doing, it provides a framework to guide clinicians, researchers and authors of practice guidance who are interested in improving approaches to risk assessment.
Rajan Nathan and Sahil Bhandari, 2022
Risk Factors for Suicidal Thoughts and Behaviors: A Meta-Analysis of 50 Years of Research
To provide a summary of current knowledge about risk factors, this study conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years.
American Psychological Association, 2016
Peer Support Services Across the Crisis Continuum
This paper offers promising and best practices to help circumvent current challenges for integrating peer support workers into the full crisis continuum. Specifically, it explores several resources available to states and organizations related to peers working in the crisis continuum, the definition and evolution of peer support services, and available national/federal guidance on the integration of peers and people with lived experience into the crisis continuum. Lastly, this technical assistance paper provides examples of the many states that are employing peers within crisis settings across the crisis continuum, overcoming challenges and barriers. This paper also looks at future directions to continue to ensure that this work evolves and grows in meaningful and positive directions.
Brinkley A, Volpe J: Peer Support Services Across the Crisis Continuum. Publication No. PEP24-01-019. Rockville, MD, Substance Abuse and Mental Health Services Administration, 2024.
When There’s a Crisis , Call a Peer How People with Lived Experience Make Mental Health Crisis Services More Effective
Peer-led and peer-staffed organizations have been supporting individuals experiencingmental health crises for years, in some cases decades. The positive outcomes experiencedby individuals “in crisis” receiving peer support are, or should be, well known. Whenpeers support those in crisis, individuals who need help are less likely to be admitted toemergency rooms and hospitals to receive inpatient care. They are more likely to participatein community-based services—which can help them avoid future crises and resultinginstitutionalization or incarceration—and be more engaged in the services they receive.They experience less self-stigma and more self-empowerment and hope. They are less likelyto need crisis services in the future.
Judge David L. Bazelon Center for Mental Health Law,. (2024). When There’s a Crisis , Call a Peer How People with Lived Experience Make Mental Health Crisis Services More Effective. In https://www.bazelon.org/ (pp. 1–94). Retrieved from https://www.bazelon.org/wp-content/uploads/2024/01/Bazelon-When-Theres-a-Crisis-Call-A-Peer-full-01-03-24.pdf
Factors Influencing the Implementation of Peer Support Specialists Within Mobile Crisis Teams: A Scoping Review of Consolidated Framework forImplementation Research Domains and Implementation Strategies
The involvement of peer support specialists in behavioral health crisis response is growing. While their roles in warm lines, crisis-receiving, and respite centers have been studied, their participation in mobile crisis teams remains under explored. This review identifies the contexts and strategies for implementing peer support within mobile crisis teams to inform broader adoption.
Chun, A. (2021). Crisis Care for Individuals with Intellectual and Developmental Disabilities | Needs Assessment. Retrieved January 15, 2025, from Guildhumanservices.org
Using Lean to Rapidly and Sustainably Transform a Behavioral Health Crisis Program: Impact on Throughput and Safety
The purpose of the study reported in this article is to (1)demonstrate how Lean principles can be applied to achieve rapid transformation of clinical operations, (2) describe strategies for sustaining change and promoting ongoing improvements, and (3) identify special considerations for behavioral health settings.
Balfour, M. E., Tanner, K., Jurica, P. J., Llewellyn, D., Williamson, R. G., & Carson, C. A. (2017). Using Lean to Rapidly and Sustainably Transform a Behavioral Health Crisis Program: Impact on Throughput and Safety. Joint Commission journal on quality and patient safety, 43(6), 275–283. https://doi.org/10.1016/j.jcjq.2017.03.008
Reflection as a Learning Tool in Graduate Medical Education: A Systematic Review
Winkel, A. F., Yingling, S., Jones, A. A., & Nicholson, J. (2017). Reflection as a Learning Tool in Graduate Medical Education: A Systematic Review. Journal of graduate medical education, 9(4), 430–439. https://doi.org/10.4300/JGME-D-16-00500.1
The Problem with 988: How America's Largest Hotline Violates Consent, Compromises Safety, and Fails the People
Leigh, J., Latty, L., Forster, O., HJ, N., Sostre, J., Pease, M., & Wang, S. (2024). THE PROBLEM WITH 988: HOW AMERICA’S LARGEST HOTLINE VIOLATES CONSENT, COMPROMISES SAFETY, AND FAILS THE PEOPLE (pp. 1–64). Retrieved from https://translifeline.org/wp-content/uploads/2024/10/The-Problem-with-988-Report-October-2024-Text.pdf
Mobile Crisis Teams’ Reliance on Law Enforcement for Multiple Key Functions
Erickson, B. R., Pope, L. G., Compton, M. T., Dixon, L. B., Odes, R., Looper, P., & Goldman, M. L. (2025). Mobile Crisis Teams’ Reliance on Law Enforcement for Multiple Key Functions. Psychiatric Services, 0(0). https://doi.org/10.1176/appi.ps.20240346
The Perils of Pondering: Intuition and Thin Slice Judgments. Psychological Inquiry
Ambady, N., The Perils of Pondering: Intuition and Thin Slice Judgments. Psychological Inquiry , October-December 2010, Vol. 21, No. 4, Special Issue on Intuition (October-December 2010), pp. 271-278
Milestones of Recovery Scale
Pilon, D. Ragins, M. (2006) Milestones of Recovery Scale https://www.markragins.com/section-6
Managing Risk in Community Integration:Promoting the Dignity of Risk and Supporting Personal Choice
Managing Risk in Community Integration:Promoting the Dignity of Risk and Supporting Personal Choice, Mark S. Salzer, The Temple University Collaborative on Community Inclusion
The Martin Gallier Project
A Welcoming Space to Manage Crisis: The Wellness Respite Program
When a person experiences severe emotional distress, crisis alternatives are a viable option instead of inpatient hospitalization to address the distress and restore balance. Peer respite programs are voluntary, short-term, crisis alternatives for people experiencing mental distress. Models have evolved in response to funding and regulatory requirements, yet research is limited. The current article describes a unique peer-led program, Wellness Respite, in operation for 7 years, including data from recent satisfaction surveys and the role of nurses in the program. Implications of a home-like, short-term crisis alternative and the role of the nurse are emphasized.