Short-Stay Crisis Units in the Emergency Department: Current Landscape and Evidence on Safety and Effectiveness

Key Messages

• Emergency departments (EDs) in Canada are experiencing ongoing overcrowding, with a growing number of visits related to mental health and substance use crises. These settings are typically not ideal for delivering mental health care due to a lack of privacy and an overstimulating environment, contributing to poor patient experiences, repeat visits, and highlighting broader gaps in accessible and effective community-based services. Short-stay crisis units (SSCUs) aim to address these challenges by providing rapid assessment and brief stabilization in a more therapeutic care setting.
• This report draws on evidence from a pan-Canadian survey of hospital-based, SSCUs and a rapid review of published evidence on the safety and effectiveness of these units in improving mental health outcomes and alleviating overcrowding in EDs. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2015.
• We received responses from 10 relevant units in 7 jurisdictions across Canada. The findings suggest a highly variable landscape. SSCUs in Canada differ in name, model of care, staffing, referral pathways, capacity, and length of stay targets. All units were open 24 hours a day, 7 days a week, and did not charge fees. Those who responded described clear benefits including a safer and calmer space for patients experiencing a crisis, fewer unnecessary inpatient admissions, and stronger links to community care. Common barriers included funding, space, staffing, unclear admission criteria, and pressure to repurpose beds during periods of high hospital demand.
• Evidence from 7 included publications suggest that SSCUs may improve some system-level outcomes, particularly wait times in EDs, length of stay in EDs, and use of restraints, but the evidence base remains limited and mixed. Findings on admissions, readmissions, and patient outcomes were less consistent, and most studies were conducted outside Canada.
• Overall, SSCUs appear promising, but they are not a one-size-fits-all solution. Their success likely depends on clear pathways, interdisciplinary staffing, stable funding, strong links to community resources, and careful alignment with local system needs. The findings of this report can be used as guidance for decision-makers across Canada who may be in the process of, or considering, implementing or making changes to SSCUs.