Michelle Heyland, MSN, APN, Rush University College of Nursing, Chicago, Illinois, USA, shared fiscal year 2014 results from a community crisis respite program called The Living Room. This program offers a cost-saving alternative to the emergency department (ED) for individuals in crisis.

According to Ms Heyland, approximately 12.5% of all ED visits in the United States involve a mental health or substance abuse diagnosis, and these are more than twice as likely to result in hospitalization than visits without such a diagnosis [Owens PL et al. Agency for Healthcare Research Quality Statistical Brief #92. 2010]. These patients tend to receive inappropriate care, for reasons including ED overcrowding, lack of priority triage, and the absence of trained psychiatric professionals to help with crisis de-escalation [Shattell MM, Andes M. Issues Ment Health Nurs. 2011; Clarke DE et al. Int J Ment Health Nurs. 2007]. Studies have shown that individuals in crisis want to visit a place where they feel safe and respected, and can talk to trained psychiatric professionals who understand their needs [Agar-Jacomb K, Read J. J Mental Health. 2009; Clarke DE et al. Int J Ment Health Nurs. 2007].

Ms Heyland described a community crisis respite center called The Living Room as one alternative to the ED for providing service to people in crisis. This was named after the familiar home space, and is offered free of charge to clients who are referred to as “guests,” in an attempt to emphasize its nonclinical environment. It provides an inviting atmosphere that is warm, welcoming, and without excessive stimuli. The layout allows for guest privacy with a separate area for rest and relaxation.

Staff members are trained psychiatric professionals, and include a therapist and a psychiatric nurse; there are also peer counselors who have a mental illness but have recovered enough to be able to offer help to others in need.

Guests who visit The Living Room are triaged by the therapist to obtain some basic demographics (Table 1), determine the nature of the crisis, and assess the guest's levels of distress, risk, and safety. They then meet with the psychiatric nurse, who establishes the guest's vital signs and also addresses any issues they may have regarding medical conditions or medications, for example.

Guests also meet with a peer counselor for in-depth discussion of the nature of the crisis, and to help identify coping skills the guest can use to decrease distress. Ms Heyland emphasized that, due to their own experiences, peer counselors are uniquely positioned to offer support and empathy and to advocate for guests.

According to Ms Heyland, initial results of this program have been positive. In the 2014 fiscal year, of 262 total visits to The Living Room, guests were deflected from attending the ED on 258 visits (98.5% deflection rate), with an average decrease of 2.44 points on the subjective units of distress scale. Since the average cost of a visit to The Living Room is $269, compared with $2500 for a visit to the ED for a psychiatric reason, the 98.5% ED deflection rate represents an estimated savings of approximately $2231 per visit, for a total annual cost savings of > $575 000 to the State of Illinois. Importantly, guests who visit The Living Room are also receiving more appropriate psychiatric care, she concluded.