Early Intervention for Mental Health Pays Off Later

SAMHSA calls for a systematic change in implementing early intervention for patients with serious mental illness.


The facts are dire: In 2014, people diagnosed with schizophrenia or mood disorders made 10.8 million visits to emergency departments (EDs). Between 2006 and 2014, the rate of ED visits related to mental health/substance abuse jumped 44%. The suicide rate among people with serious emotional disturbances (SEDs) is 25 times higher than that in the general population. Two million people with serious mental illness (SMI) are jailed annually, but only about 1 in 3 is currently receiving any treatment.

However, early intervention for SMI can help many people stay out of EDs and jails. That is the focus of The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers , a report recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA).

“The emergency room is not a place for people that are experiencing exacerbations of mental health conditions,” says Elinore McCance-Katz, MD, PhD, assistant secretary for mental health and substance use at SAMHSA and chair of the Interdepartmental Serious Mental Illness Coordinating Committee, which produced the report.

In the report, the committee cited the 2003 President’s New Freedom Commission on Mental Health, which concluded that America’s mental health service delivery system was “in shambles,” with “fragmented, disconnected and often inadequate” mental health services and supports. Yet a number of the commission’s recommendations still have not been implemented or only “partially realized,” the committee notes.

In an interview with, McCance-Katz says the solution is a “national system of crisis intervention services”—a continuum of care with outpatient services as alternatives to inpatient care. Most states report insufficient psychiatric crisis response capacity, as well as insufficient numbers of inpatient psychiatric hospital beds. If the right system, one that includes community interventions and adequate resources, were in place, McCance-Katz says, “we might not need so many beds.”

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