A psychiatric emergency is often mistakenly thought of as a worrying, but perhaps one-off event. Something reaches a breaking point, the person gets help, stays in emergency care for a while, and the crisis passes.Â
But for a large number of adults living with serious mental health conditions, this explanation doesn’t match their reality. For this group, the emergency room can become an all-too-familiar place, with multiple hospitalizations every year.
Frequent psychiatric hospitalizations and repeated mental health crisis visits are more common than many people realize. Understanding why they happen is the first step toward creating a treatment and recovery plan that helps prevent mental health crises. To help you gain this understanding, this page will cover:
To understand frequent crisis care, it helps to first clarify what crisis care actually involves. Crisis care is a part of the mental health system that was designed to respond to situations that have reached the point of immediate risk. Crisis care comes in different forms, including:
Once a person is stabilized and the immediate crisis has passed, the aim is to then connect them with follow-up care.Â
Frequent crisis care use is exactly what it sounds like. It means a person returns to these services repeatedly. Chronic psychiatric crisis patients often find themselves cycling through these services, not because they aren’t trying to get better, but because the care available between crises isn’t sufficient to keep them stable.
While there is no specific set of guidelines that classify someone as a frequent user, the general threshold is someone who has had multiple crisis contacts within a single year.
Frequent crisis care is a lot more common than many people are aware of. A meta-analysis showed that around 16% of adults discharged from a psychiatric inpatient unit are readmitted within 30 days.[1]Â
Research on emergency department visits for psychiatric reasons specifically found that 28.2% are classed as high utilizers of mental health care.[2] But the emergency department is only part of a wider picture, and the same dynamic can be observed when we bring our attention to crisis helplines.
One review of crisis helplines found that between 2.6% and 22% of all calls to crisis helplines come from frequent callers.[3] This is important because it shows that a person doesn’t need to be physically present at a hospital to be in a crisis.
It suggests that a notable percentage of people continue to experience unmet needs between crisis episodes, leading them to repeatedly seek support. Frequent visits to the emergency room (ER) for mental health reasons and repeated crisis line calls often reflect the same underlying problem. There is a gap between the stabilization support received and what sustained recovery requires.
But ER visits following helpline contact are only a fraction of what is actually happening. The full picture includes crisis calls that never become hospital visits and episodes managed at home without any professional help being sought.Â
If you or someone you’re close to has been accessing frequent crisis care, you are likely frustrated or worried about the cycle continuing to repeat. While the reasons for this can vary from person to person, it is very rarely about a lack of effort on the part of the person in crisis.
Several factors contribute to what is sometimes called revolving door psychiatry. This is where the same people cycle through crisis services repeatedly despite everyone’s best efforts. These factors include:
Emergency mental health admissions through departments and short-stay units are built with short-term safety in mind. While reviews show that these services can reduce the need for full psychiatric admission and shorten urgent care waiting times, they aren’t designed for long-term care.[4]
The average psychiatric inpatient stay for serious mental illness is less than 10 days, which is enough time to adjust medication and bring an acute episode under control.[5] While valuable in the moment, this is not enough time to address the condition that’s causing the episodes in the first place. In some cases, once the person is stabilized, they’re discharged back into the same circumstances that put them there in the first place.
This is where a gap can emerge between crisis stabilization and sustained treatment, creating the conditions for another episode to develop. High-risk mental health patients often need more than just crisis stabilization for adults. They need extended treatment that addresses root causes rather than just acute symptoms.
Research on post-discharge outcomes found that medication adherence and attendance at follow-up appointments were predictors of whether someone would be readmitted.[6] The same review identified that the housing situation at discharge was the second most important factor.
This shows us that if the follow-up process is difficult, like being given a set of phone numbers and expected to book appointments when you’re at your most depleted, it can affect what happens next.
Studies show that a follow-up within 30 days of discharge is protective against readmission, but when that follow-up doesn’t happen, the protective window starts to close.[6]
Certain mental health diagnoses carry a higher risk of repeated crisis episodes. A meta-analysis ranked schizophrenia as the highest risk for 30-day readmission, followed by personality disorders and bipolar disorders.[1]
These conditions require sustained, specialized care that short crisis stays aren’t equipped to provide.
If a person has been diagnosed with these types of conditions in the past, there’s more than likely a long-term plan in place. But it’s worth considering the rate of misdiagnosis, as with schizophrenia alone, the misdiagnosis rate was found to be 23.71%.[7] This means it’s more than possible for a person to be trapped within frequent crisis care, undiagnosed, or misdiagnosed, with a condition that has the highest risk for readmission.
Clinical treatment alone can’t hold someone stable if the environment they return to keeps destabilizing them. Research notes that issues like homelessness, substance use, and even a lack of insurance coverage all increase the likelihood of frequent psychiatric emergency visits.[2]
This is heartbreaking to consider because the person can be doing everything right, clinically, but unstable housing or financial pressure is consistently pulling them back to square one.
AMFM is here to help you or your loved one take the next steps towards an improved mental well-being.
While there’s never going to be one, sure-fire way to break the readmission cycle, research does show several approaches that have shown success in reducing frequent psychiatric hospitalizations.Â
One review found that interventions that focus on the transition from the hospital to outpatient care reduced readmissions between 13–37%.[8]
The most effective parts of these interventions were found to be assessments before discharge, as well as contact with the patients in the days following discharge.
A model called Critical Time Intervention was found to be helpful during these times, and data show it reduced the odds of psychiatric rehospitalization by around 89% in a randomized trial.[9] A large portion of this success could be attributed to the length of time it runs, which is nine months.Â
Programs where the same team follows you from crisis stabilization through to outpatient management produce better outcomes, and it’s easy to surmise why. If the same team that helped stabilize you is with you throughout the whole process, it can feel a lot safer.Â
Assertive Community Treatment (ACT) is a team-based approach that aims at keeping you in contact with the necessary services and reducing hospital admissions. It is seen as an alternative to standard community care and traditional hospital-based rehab.[10]
Research found that those receiving ACT were more likely to remain in contact with services and less likely to be admitted to the hospital. For those who did need to stay in the hospital again, the time spent there was less compared to those receiving standard community care.[10]
This suggests that a consistent level of care can improve the outcome and patient satisfaction.
Research has found that prior admission history is one of the strongest independent predictors of 30-day readmission.[1] What this tells you is that repeated crises under the same treatment plan may be a clinical signal themselves. In some cases, the whole treatment plan may need to change, not just the medication dose.
Post-discharge research shows that the type of discharge plan and the housing arrangement at the point of leaving the hospital are both predictive of whether someone will return.[6]Â
Regular reassessment and medication review are part of what keeps someone stable, but so is diagnostic clarity. A diagnosis made during a crisis may not reflect the full picture once things have settled, and treatment aimed at the wrong target will keep producing the same results regardless of how many times the cycle repeats.
If you’ve been through multiple psychiatric crises in the past year and feel as though there’s no progress taking place in between episodes, it’s a clear sign that something has to change.Â
It’s also crucial to consider a different level of care if you’ve found yourself readmitted within 30 days after being discharged.
This next level of care could look like residential treatment, which gives clinicians the time that they need to do the work that crisis stabilization for adults can’t achieve in a short stay.
Research shows that structured transitional interventions reduce readmission rates by up to 37%.[8]
If what you’re feeling now is uncertainty or worry about moving into a more intensive program, it’s not something you have to work out on your own. A clinical team experienced in complex psychiatric presentations can help you assess your current situation and what the right next step looks like.Â
Your circumstances are taken into consideration, too. This means that if you’re currently going through a period of difficulty with substance use or a complicated housing situation, professional psychiatric guidance can help you plan accordingly.
If what you’ve read on this page has given you some form of clarity on why this sequence keeps repeating, the next step is to act upon it. Staying in a level of care that has already shown it doesn’t match your situation and can’t keep you stable between crises costs you time and effort.Â
AMFM (A Mission For Michael) Mental Health Treatment provides mental health care for adults experiencing conditions like:
Our clinical team is experienced in working with complex psychiatric presentations where standard care hasn’t been enough. We offer sustained, intensive treatment that can finally address the underlying condition rather than just managing acute episodes.Â
AMFM has residential programs at our locations in California, Minnesota, and Virginia for those who need the structure of a full-time therapeutic environment, along with intensive outpatient options for those who need flexible support around daily life.
We accept insurance and are in-network with most major providers. To check your insurance coverage for mental health care, simply complete our confidential online verification form or call us at 866-478-4383. Â
Contact us today, and a caring member of our team will be more than happy to talk through your options and help you start the admissions process.
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There is no single clinical cutoff, but most research defines it as two or more psychiatric admissions within a 12-month period. A meta-analysis found that roughly 16% of adults discharged from psychiatric inpatient care are readmitted within 30 days.[1]
Long-term psychiatric care plans that include regular reassessment and medication review help keep someone stable between crises rather than cycling back through emergency services.
Crisis intervention for adults includes settings like psychiatric emergency departments and short-stay inpatient units, along with telephone crisis lines. The goal is to stabilize and connect the person with follow-up care.
At AMFM, we strive to provide the most up-to-date and accurate medical information based on current best practices, evolving information, and our team’s approach to care. Our aim is that our readers can make informed decisions about their healthcare.
Our reviewers are credentialed medical providers specializing and practicing behavioral healthcare. We follow strict guidelines when fact-checking information and only use credible sources when citing statistics and medical information. Look for the medically reviewed badge on our articles for the most up-to-date and accurate information.
If you feel that any of our content is inaccurate or out of date, please let us know at info@amfmhealthcare.com
