Designing behavioral health crisis care environments for better outcomes
Manjiri Bapat and Stephanie Vito
September 7, 2026
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When someone is having a medical emergency, they will be able to receive care in the emergency department, with a wait time dependent on the severity of their condition. But for those experiencing an acute mental health crisis, there is not always a safe space readily available with trained staff. These patients can end up languishing in the ED, being discharged without appropriate follow-up care or not seeking care at all.
As the mental healthcare access crisis continues across the country, healthcare organizations are focusing on creating mental health-specific spaces that alleviate the burden on the ED, which often has a domino effect on the rest of the inpatient beds available. One solution is a Behavioral Health Crisis Unit, a 24/7 facility designed to stabilize people experiencing a mental health crisis and connect them with immediate and specialized treatment.
What is a Behavioral Health Crisis Unit (BHCU)?
A Behavioral Health Crisis Unit can be a more appropriate landing spot for patients in crisis that may walk into an emergency department or arrive there by ambulance. It can also be an alternative to being detained by law enforcement. Upon arrival, staff can quickly assess if they need medical treatment or diagnostic tests before being sent to the BHCU. There is plentiful research showing the benefits of BHCUs — reduced inpatient stays and length of stay, lower emergency room wait times — but less is known about the benefits of different BHCU locations.
While the internal workings of Behavioral Health Crisis Units remain consistent, the placement of the BHCU in relation to the ED can make a difference in the speed and type of patient care. There are four typical options for Behavioral Health Crisis Unit placement:
- Inside or directly adjacent to an emergency department as its own unit
- Elsewhere on a hospital campus, still accessible but detached from the ED
- Within a behavioral health center off campus/not near an ED
- A freestanding BHCU, unaffiliated with an ED
We researched these four BHCU scenarios, using projects from within and outside CannonDesign’s portfolio, to determine which are more likely to have improved patient outcomes and better patient experiences. We also factored in length of stay from admission to discharge and reduced emergency department wait time.
Type 1: Adjacent to emergency department
Type 1: Adjacent to emergency department
At Unity Health’s Trinity Rock Island Hospital, the BHCU was placed directly adjacent to the ED to accommodate an increasing number of behavioral health patients arriving at the ED. It contains six private rooms across from a "living room" space that acts as an open lounge.
Result: A 50 percent reduction in emergency room waiting times and a 46 percent reduction in length of stay.
Type 2: Detached from emergency department, on campus
Type 2: Detached from emergency department, on campus
Johns Hopkins Howard County Medical Center’s new Crisis Stabilization Unit is a 500-foot walk from the emergency department. It has 16 semi-private rooms and eight recliners in an open area.
Result: A 50 percent reduction in emergency room waiting times and a nine percent reduction in inpatient admissions
Type 3: Part of behavioral health services, not near emergency department
Type 3: Part of behavioral health services, not near emergency department
The Banner University Medicine Crisis Response Center on the Banner University Medical Campus in Phoenix is within the institution’s behavioral health hospital, on campus but across a parking lot from the emergency department. It has 24 recliners available for adolescent or adult patients.
Result: A 40 percent reduction in emergency room waiting times, a 55 percent reduction in length of stay and a 50 percent reduction in inpatient admissions
Type 4: Freestanding outpatient BHCU
Type 4: Freestanding outpatient BHCU
San Diego County’s Crisis Stabilization Unit in Oceanside, California was built to offset high volumes of behavioral health patients in other County emergency departments. It is meant to serve the adjacent community as an alternative to going to the ED. This facility has a 16 recliner unit, but needs to transfer patients if they are medically complex or require more intense behavioral health inpatient care.
Result: Only five percent of patients needed to be transferred (self-reported figure)
More about the Type 2 solution
Expanding on the Type 2 solution above, a recent project at Johns Hopkins Howard Medical Center saw a shift from a BHCU within the emergency department to a new unit within the hospital but detached from the ED. So why the shift?
The existing BHCU was close to the ED walk-in entrance and to the ambulance drop off area, so it was easy to access in multiple patient scenarios. It was also on the same floor as the hospital’s inpatient behavioral health unit for patients who needed to be transferred. However, the transfers were done through a public corridor with a long distance for someone who may be in a mental health crisis. The existing BHCU also only had six beds, and wait times were still high as the number of behavioral health patients needing care increased.
Transitioning to a BHCU not within the ED but still on the Johns Hopkins Howard Medical Center campus not only allowed for an opportunity to create a more modern unit with updated safety features but also expand the number of beds to reduce wait times for those needing care.
The solution involved moving the inpatient behavioral health unit to a different floor of the medical center, freeing up that space for a larger BHCU that was still relatively close to the ED. Visibility was a main driver during the renovation, with the staff workspace overlooking two open milieu spaces for patients to come out of their rooms, socialize or just watch TV. The treatment rooms are just beyond those activity spaces, still visible to staff at their work station.
The station is open so it blends in better with the activity space and keeps that optimal visibility. A safety consideration made was to make the station itself deeper, to put more distance between staff and patients should an incident occur. Furniture, fixtures and hardware choices were made with safety in mind.
Since opening in December 2024, the Johns Hopkins Howard Crisis Stabilization Unit recorded improved metrics:
135%
increase in patient throughput
30%
of patients make it from the EDU to the BHCU within an hour
50%
reduction in average length of stay
13%
reduction in violent incidents
Analyzing the effect of where a BHCU is located in relationship to emergency departments can help healthcare institutions make evidence-based decisions on how to better plan and design out their own BHCUs and other mental health services. It is clear distance has an impact on care, but things like proximity to inpatient units, the layout and patient experience of the BHCU and availability of a full spectrum of mental health resources matter as well.
Behavioral Health Crisis Units are an important piece of improving access to mental healthcare and relieving some of the burden placed on emergency departments. As our limited research shows, key to their success in achieving some of these metrics is where they are placed on hospital campuses and within their communities.
