Since opening its crisis response center, the Hospital of the University of Pennsylvania — Cedar Avenue has seen a significant and sustained decrease in the number of psychiatric visits at its emergency department.
The crisis center is part of a larger initiative to restructure Penn Medicine’s approach to psychiatric care. Six months after the center opened in 2023, the number of psychiatric visits at HUP-Cedar Avenue’s emergency department had decreased by 80% — a number that has since remained relatively stable, according to a report from Becker’s Behavioral Health.
In an interview with The Daily Pennsylvanian, Perelman School of Medicine Clinical Psychiatry professor Katharine Dalke — who is also Penn Med’s vice chair for clinical operations in the psychiatry department — attributed the decline in emergency department consults to the ability of patients “to be seen in the CRC space itself.”
Dalke explained that prior to the center’s opening, “there was no dedicated psychiatric space for patients at HUP-Cedar,” which meant that “if a patient needed to be seen in the emergency setting, a psychiatrist had to come to the emergency room to see them.”
A crisis response center on the same site had previously operated as part of Mercy Philadelphia Hospital before its closure in March 2020. The campus subsequently transitioned to the Public Health Management Corporation Health Center on Cedar, which includes HUP-Cedar Avenue.
“Patients come to the CRC either voluntarily or involuntarily,” Dalke said. “As soon as possible, they’re evaluated by our nursing team to get a sense of what’s bringing them in to make sure that they’re not acutely medically ill and can be safely cared for in the crisis center.”
In cases such as opioid withdrawal, Dalke noted, patients are sent to the emergency department to receive immediate medical care before any psychiatric evaluation.
Dalke said that once acute medical issues are addressed, a “specialist mental health provider” evaluates patients to determine appropriate next steps. She added that providers have a “moral, ethical, and legal obligation” to “treat patients in the least restrictive treatment setting,” such as being “cared for as an outpatient” with weekly visits to a doctor or a therapist instead of a hospital stay.
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Designated crisis centers in Philadelphia must also be able to accommodate and treat patients brought in involuntarily “who are at high risk by definition of harm to themselves or other people because of their circumstances.”
Consequently, Dalke said, crisis centers “need to be places that are extraordinarily safe for the patients, but also to be extraordinarily safe for the staff.”
Providing appropriate and effective psychiatric care, Dalke said, requires significant investment.
“It takes a lot of planning, a lot of time, and is also expensive, not just to build the space, but to be able to staff it properly,” she said.
Overall, Dalke explained that crisis centers “function really well as safety nets” that provide “a layer of support for people when they’ve slipped through the other cracks in the system.”
However, she said that they are not intended to provide prolonged care and that it is “very unusual for people to stay with us longer than a day.”
“Something that I’m really interested in — and the city is really interested in — is the question of how do you meet people in a moment of crisis and get them started on a more proactive path to recovery that’s not just about reacting to a crisis or someone slipping through the cracks,” Dalke said.
Dalke also highlighted the center’s partnership with Wellness at Penn, saying that they aim “to provide mental health services for Penn students in crisis as close to Penn’s campus as possible” in the HUP Pavilion emergency department.
“We are, of course, also available for students who want and need to come to the Cedar Crisis Response Center on their own,” she added.
