Health Technology Review

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

The Challenge

• 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.

The Evidence

• 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.

What We Found

• 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.

Why it Matters

• 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.

Context

Mental Health Crisis Care and Emergency Department Overcrowding

Emergency department (ED) overcrowding is an ongoing issue in Canada. An important group accessing the ED are people experiencing acute mental health crises. Internationally, visits to the ED for mental health concerns are increasing while the number of available beds is decreasing, resulting in challenges in providing timely and appropriate care.^1-3 In Canada last year, approximately 10% of people who had at least 1 ED or urgent care centre visit for mental health and substance use, had 4 or more visits for the same concern in a 365-day period.⁴ ED boarding times (the time a patient remains in the ED after a decision to admit has been made)⁵ for patients presenting with mental health concerns have also been found to be disproportionately longer compared to other patient presentations.⁶

EDs are not an ideal environment to treat patients with mental health concerns, and are reported to have negative impacts on mental health due to the overstimulating environment, lack of privacy, long wait times, and competing clinical needs.⁷ This can make relationship building between the treating physician and patient particularly difficult, especially when compounded with language or cultural differences. Access to care can be especially hard for people who are racialized, people experiencing homelessness, Indigenous Peoples, and people with lived experience of substance use.⁸ In 2024, 41% of adults in Canada with a mental health disorder reported an unmet need for mental health care.⁹

Short-Stay Crisis Units

Short-stay crisis units (SSCUs) are hospital-based units typically located in or near an ED. They offer a therapeutic space for stabilization, assessment, and appropriate referrals for people experiencing a mental health crisis. SSCUs currently exist across Canada and internationally and may be referred to by different names, including emergency psychiatry assessment, treatment, and healing units; behavioural assessment units; psychiatric emergency services; psychiatric observation units; crisis stabilization units; and psychiatric decision units, among others.

SSCUs were originally conceptualized as a response to the rising number of people presenting to the ED with mental health crises and the need for specialized care.¹⁰ Objectives are typically 2-fold: reduce pressure on EDs by improving patient flow via a dedicated pathway, and provide better quality of mental health care.^3,11 SSCUs function on a few key assumptions: that a structured, calm space is more healing for an individual undergoing an acute mental health crisis than a general ED waiting room; that acute distress is time-limited and short, targeted intervention can shift the trajectory of care; that timely assessment by trained staff can identify the appropriate interventions needed; and, that avoiding unnecessary inpatient admissions is beneficial to both the patient and the system.

When assessing the effectiveness of SSCUs, relevant outcomes include ED length of stay (LOS), total LOS, readmission rates, inpatient admissions, use of outpatient services, medication stabilization, and patient-reported outcomes. ED LOS is defined as the time from ED arrival (triage or registration) to physical departure from the ED (discharge, admission, or transfer). Total LOS includes total time in both the ED and the SSCU.

Why Is It Important to Do This Review?

The number of visits to the ED for acute mental health crises are continually increasing in Canada.^6,8,12-14 In a series of reports published by Canada’s Drug Agency on emergency department overcrowding, SSCUs were identified as a potential intervention to help alleviate ED overcrowding and improve patient outcomes in settings where mental health-related presentations represent a substantial proportion of visits. A review of the available evidence and the current landscape of these units across Canada is important to guide informed decision-making regarding their implementation into clinical practice.

Purpose and Objectives

To support decision-making around mental health crisis care and ED overcrowding, we prepared this Environmental Scan to summarize information on the current landscape of SSCUs in Canada and to summarize the available evidence regarding their safety and effectiveness. This review also summarized the available evidence on patient and staff experiences with this intervention.

Research Questions

1. What is the landscape of short-stay, hospital-based crisis units across Canada?

2. What evidence exists on the safety and effectiveness of short-stay crisis units in alleviating emergency department overcrowding?

3. What evidence exists on the safety and effectiveness of short-stay crisis units in improving patient mental health outcomes?

Approach

We conducted an Environmental Scan to capture a variety of information related to SSCUs. This scan consisted of a survey and a literature search. To address research question 1, we conducted a survey to capture information about SSCU models, components of care, and implementation considerations, targeted at relevant personnel from SSCUs across Canada. To address research questions 2 and 3, an information specialist conducted a customized literature search, balancing comprehensiveness with relevance, of multiple sources and grey literature on December 12, 2025. The main search concept was SSCUs, and the search was limited to English-language documents published since January 1, 2015. A more detailed summary of methods is available in Appendix 2.

Findings

Survey Results

This section addresses the following research question:

1. What is the landscape of short stay, hospital-based crisis units across Canada?

The findings presented are based on survey responses received between March 17, 2026, and April 13, 2026. We received 14 survey responses for 9 of 13 jurisdictions in Canada (i.e., Newfoundland and Labrador, Prince Edward Island, Nova Scotia, New Brunswick, Ontario, Saskatchewan, Alberta, British Columbia, and Nunavut). Ten of these responses spoke specifically to SSCUs consistent with our definition, while 4 described other models of mental health care in the ED setting. We have excluded these 4 responses from the main findings of this report but have provided a brief description of these alternate models in the section titled Other Models of Psychiatric Emergency Services. Table 1 and Table 2 provide a summary of the structural and operational components of the SSCUs identified in the survey.

We sent invitations to participate in the survey to a total of 40 individuals across 11 jurisdictions. We targeted staff familiar with specific SSCU delivery models, services provided, staffing, hours, and other structural, operational, implementation, and evaluation considerations. Those who responded included 3 individuals whom we contacted directly as well as 11 individuals who subsequently received the survey invitation from the initial contacts. They reported holding positions such as psychiatrist, unit manager, program medical director, nurse manager, and social worker. A list of participating organizations is provided in Appendix 4, Table 8.

Models of Care

We provided those who responded to the survey with the following definition of an SSCU and asked if it aligned with the model they used: “A mental health assessment service that is hospital-based, allows overnight stays (less than 1 week), and primarily aims to assess and stabilise patients undergoing a mental health or behavioural crisis, with the purpose of reducing the need or length of stay of standard acute psychiatric admission, and/or reducing mental health presentation or length of wait at the emergency department.”¹⁵

Most people who responded noted that this definition aligned with the model of care they used. Four specified that they aim for an LOS of less than 72 hours, while 1 indicated a maximum LOS of 48 hours. However, in most cases, those who responded suggested that LOS is not strictly enforced, depends on presentation, and if longer stays are required patients can be transferred to the psychiatric inpatient unit. All who responded noted that the primary purpose of the SSCU is either to help alleviate ED overcrowding or to reduce inpatient psychiatric admissions. While all SSCUs were located within hospitals, the SSCU in Newfoundland was located specifically in a mental health and addictions centre. In Nova Scotia, the SSCU is located on a different floor, separate from the ED.

SSCU Position Within Community Mental Health Care Model

Seven of 10 people who responded indicated that the jurisdiction within which their SSCU operates follows a “stepped care” model for treating patients with mental health concerns, and that the SSCU is incorporated into this model. A stepped care model refers to a system in which services are organized based on patient acuity, starting with the least intrusive intervention necessary and allowing a “step up” to more intensive care or a “step down” to less intensive care.¹⁶ Most people who responded to the survey indicated that their SSCU is meant to serve individuals who require more intensive care (e.g., acute detoxification, crisis stabilization) than what is available in the community, but less intensive care and shorter LOS than an inpatient unit. One person who responded from a large, 21-bed unit in Alberta indicated that they have both high observation, secure rooms as well as regular rooms available within their unit, so individuals can transition between those 2 levels of care within the unit as required.

Those who responded from both Prince Edward Island and British Columbia noted the importance of “bridging” programs that serve as a transition from the SSCU back to the community. In Prince Edward Island, there is a service that will check in on patients who were discharged within 72 hours of their psychiatric emergency visit. In British Columbia, the “Bridging Care Program”¹⁷ is a recovery-oriented day program that offers group and individual therapy and training, Monday to Friday, that is often used for patients discharged from the SSCU.

Numerous people who responded mentioned challenges in maintaining patients of the appropriate acuity in the SSCU. In some cases, it was noted that patients receiving acute care will often get admitted to the SSCU when there are no spaces available in the acute care units. A person who responded from Alberta noted an influx of patients who would not require SSCU admission if they had access to appropriate community resources.

Population Served

Almost all people who responded indicated that the SSCU serves only adults from mostly urban populations. The most notable exception was a unit in Ontario that serves adults and adolescents 16 years of age and older, from a mostly rural population. Another unit from Ontario and the 1 in Prince Edward Island indicated that they serve both adult and pediatric patients.

Referral Pathways and Admission

All SSCUs receive patients directly from the ED. In all instances, patients were required to complete the full ED pathway (i.e., triaged and medically cleared by a clinician in the ED) before being admitted. Two units also allowed self-presentations, and 2 accepted referrals from outpatient psychiatry. One person who responded from Calgary noted that they have patients referred from EDs across the city (not just from the hospital where the SSCU is located). Most SSCUs required formal admission of patients, while 1 was described as an observation unit, and 1 required hospital registration and creation of an ED chart but patients were not formally admitted.

Staffing

In most cases staffing in the SSCUs included a combination of clinical and support staff. Clinical staff included emergency physicians, psychiatrists, nurse practitioners, registered nurses, psychiatric nurses, registered practical nurses, occupational therapists, recreational therapists, social workers, and addiction counsellors. Support staff included outreach workers, security, and reception and clerical support. At a minimum, all units reported employing psychiatrists, registered nurses, and social workers. Approximately one-half of those who responded reported employing reception and clerical staff. A detailed list of staff by province is provided in Appendix 1, Table 4.

Services Provided

All the SSCUs identified in the survey provide assessment and stabilization, crisis counselling, medication review and prescription, and referrals and discharge planning. Some units also provide short-term case management. One unit in Ontario provides community treatment orders, and placements with community addiction services or long-term care.

Substance Use and Addictions Care

Most people who responded indicated that their SSCU serves both individuals presenting with mental health concerns and those with substance use and addiction concerns. Three of these indicated that the triage process differs slightly for those presenting with substance use as their main concern, with those individuals requiring a full assessment in the ED before being admitted. Treatment modalities for those with substance use concerns were also slightly different, with 1 unit in Ontario indicating that patients waiting for detoxification participate in virtual groups from an addictions treatment facility.

One unit in Alberta indicated that staff from their Acute Care Addiction Recovery Program¹⁸ are heavily involved in the care of individuals presenting with substance use to monitor withdrawals, plan treatment, and connect with community-based care. Patients seeking sobriety are connected with treatment centres; those not seeking sobriety, are supported and connected to community resources and discharge. Another response indicated that they aid with withdrawal management, and another that those patients can get referred to the addictions liaison team.

Table 1: Summary of Structural Components

ED = emergency department; MH = mental health; NR = not reported; SU = substance use.

^aSurvey options included “government,” “hospital,” “private,” or “other.” No further details were provided.

Table 2: Summary of Operational Components

ED = emergency department; EM = emergency medicine; FTE = full-time equivalent; LOS = length of stay; NR = not reported; PES = psychiatric emergency services; SSCU = short-stay crisis unit.

^aSurvey responses indicative of planned operations if the unit had ever opened.

^bSeventy-two hours is the goal, but it depends on the presentation. The SSCU does take patients receiving acute care so it can be difficult to meet this goal.

Table 3: Summary of Services Offered at SSCUs in Canada

CAS = community addiction services; CTO = community treatment order; LTC = long-term care; SSCU = short-stay crisis unit.

Implementation Considerations

Facilitators and Barriers

The most common facilitator to opening and operating SSCUs, as indicated by those who responded, was the presence of experienced, supportive staff that understand the model of care. Those who responded to the survey also indicated that it was important to have input from physicians, the community, and those with lived experience into the planning and service model of the unit, and physician interest in managing and treating complex cases. Other facilitators were sponsorship from hospital leadership, funding, clear admission criteria, physical space, fast turnaround of patient admission and care processes, and appropriate, interdisciplinary staffing levels.

Common barriers to opening and operating SSCUs identified by those who responded included appropriate staffing, lack of funding, and suitable physical space. One person who responded indicated the need but difficulty in ensuring 24 hours a day, 7 days a week support from a psychiatrist. In numerous cases, those who responded indicated that due to high patient volumes in the general ED, SSCUs had difficulty operating as separate units, with their beds often repurposed as additional acute care spaces. Another theme was a general lack of understanding from administrators and ED staff of the SSCU model, and a lack of clarity around which patients are eligible for the unit.

In 1 case, where the SSCU is embedded within a psychiatric ED, the person who responded indicated that there is nothing in the environment to distinguish those admitted to the SSCU from those just arriving for assessment or those waiting for admission to the inpatient unit. Therefore, it is challenging to have an SSCU-specific service model or programming.

Benefits and Drawbacks

The most reported benefits of SSCUs revolved around improved patient care. Six people who responded to the survey indicated that patients are assessed and stabilized in a safe setting by experienced staff, with 2 people who responded to the survey indicating that they often have a shorter LOS. Four people who responded to the survey identified reduced avoidable inpatient admissions and connections to community resources for ongoing support as benefits. One person who responded noted the opportunity to support longer-term recovery through connections to community programs.

A frequently reported drawback of SSCUs was that the unit may become a default disposition for patients presenting to the ED with a crisis to avoid decision-making, especially where there is a lack of understanding of their services and of admission criteria. Additional concerns included units being repurposed due to system pressures such as bed shortages or staffing issues (2 people who responded), premature patient discharge (1 person who responded), and challenges in creating safe discharge plans for patients with needs beyond the scope of crisis services (e.g., housing) (1 person who responded).

Other Models of Psychiatric Emergency Care

We received 4 responses describing models of care for emergency psychiatry that do not fit the definition of an SSCU. Two responses representing 3 hospital sites in Ontario indicated that they have separate, locked areas within the ED used for the assessment of patients presenting with mental health concerns but that do not allow for overnight stays and focus on medical treatment rather than therapy or skill building. These units indicated that barriers to implementing an SSCU include funding for trained staff capable of providing focused therapy, and provincial directives that advise against holding patients with mental health concerns in the ED. One response from New Brunswick indicated that while they do not have a dedicated SSCU, they have 4 beds within their psychiatric inpatient unit with concentrated nursing care with the goal of crisis stabilization and an LOS of less than 72 hours. Consistent with most responses, the largest barriers to a dedicated unit were space, funding, and staffing.

Figure 1: Case Study — SOA Unit, Royal Alexandra Hospital, Edmonton, Alberta

ACT = acceptance and commitment therapy; DBT = dialectical behaviour therapy; ED = emergency department; FTE = full-time equivalent; LOS = length of stay; SOA = safe observation and assessment; SSCU = short-stay crisis unit.

Source: Reproduced with permission from Dr. Mark Corie, Psychiatrist, Royal Alexandra Hospital.

Literature Findings

This section addresses the following research questions:

2. What evidence exists on the safety and effectiveness of short-stay crisis units in alleviating emergency department overcrowding?

3. What evidence exists on the safety and effectiveness of short-stay crisis units in improving mental health outcomes?

We included 7 publications from the literature search that met our inclusion criteria (Appendix 2, Table 6): 1 systematic review (SR),¹⁹ 2 before and after interventional studies,^20,21 1 mixed-methods study,³ 2 qualitative studies,^22,23 and 1 cross-sectional observational study.²⁴ Studies were conducted in Australia,^11,19,23 France,²⁰ South Africa,²⁴ the UK,³ and the US,^21,22 with most focusing on adult populations, and 1 including adolescents. A list of other references of potential interest can be found in Appendix 5.

Unit Characteristics

Across the included studies, most SSCUs were operating 24 hours a day, 7 days a week^11,20,23 with capacity ranging from 5 to 12 beds^{3,11,20,21,23} and maximum LOS ranging between 24 to 72 hours.^3,11 Units were implemented across diverse hospital settings and governed by mental health^3,11 or clinical toxicology services²³ rather than emergency medicine.

Staffing models were multidisciplinary, including nurses (mainly mental health nurses), physicians, social workers, and addiction specialists.^{3,11,20,21,23,24} Most units operated with relatively high staff to patient ratios, such as 1:1 or 1:2.³ Referral pathways commonly originated from the ED, intensive care unit, inpatient wards, or community services, with patients typically requiring medical clearance before admission.^3,20,23 Care focused on assessment, stabilization, and discharge planning with community linkages.^11,20,21,23

Summary of ED Overcrowding and Mental Health Outcomes

A mixed-method study performed in the UK comprised a survey, SR, interrupted time series, synthetic control study, cohort study, and qualitative interviews, with a critical interpretive synthesis approach.³ Within the SR component, the authors of several primary studies reported a positive association between implementation of an SSCU and reductions in ED wait times and long waits (greater than 24 hours), although others reported there were no substantial changes compared to preimplementation or control sites.³ The authors reported that limited evidence suggested reduced ED boarding time following SSCU implementation in before and after studies or when compared to patients visiting a hospital without an SSCU.³ The authors went on to report that SSCUs were associated with reduced psychiatric admissions in the short term; however, findings were inconsistent, with no long-term effect,³ and there was some evidence of increased admissions following initial SSCU use.³ Finally, authors noted that SSCUs were also associated with shorter inpatient LOS, and that limited evidence suggested no substantial impact on suicidality or risk of repeat attempts.³

An SR included 14 studies from Australia, Canada, and the US examining the effectiveness of SSCUs in improving patient flow through the ED. The authors concluded that evidence consistently showed improvements in ED LOS and reductions in the use and duration of restraints, as well as fewer patients restrained.^3,19 Findings for readmission rates were inconclusive with unclear comparators.¹⁹ One primary study conducted in the US (N = 2,369) examined both ED LOS and total LOS before and after implementation of an SSCU serving adolescent patients aged 12 to 17 years. Authors reported no significant change in total LOS for patients who were eligible for the unit, but a significant decrease in ED LOS. This was associated with a decrease in beds lost to boarding in the pediatric ED of 544 hours per month.²¹ Another study, conducted in France (N = 348), also reported a reduction in ED wait times after the implementation of an SSCU.²⁰

Staff and Patient Experiences

Two qualitative studies,^22,23 1 mixed-methods study,³ and 1 cross-sectional survey study²⁴ explored the experiences of patients and staff in SSCUs. The qualitative interview study (N = 73) within the mixed-methods study included first-time visitors to SSCUs, members of the units’ clinical teams, and clinicians referring to the units. The authors noted that patients generally reported more positive experiences in SSCUs compared to EDs, describing units as clean, calm, and safe.³ Although concerns about noise, privacy, and safety were noted, staff were often perceived as empathetic, approachable and nonjudgmental, providing a more humanizing experience.³ However, patients in some settings reported limited interaction with staff, particularly in shorter-stay units which left them isolated and confused.³ The authors also noted that staff felt that SSCUs provided a therapeutic, calm, and appropriate alternative to care in the ED, and that they valued the multidisciplinary and nurse-led models, which enabled skill development and autonomy.³ Staff highlighted challenges related to communication, referral processes, and system pressures, as well as the emotional demands of the role.³

In 1 study investigating the experiences of people presenting to the SSCU with alcohol or drug intoxication,²³ the authors noted that patients described receiving expert, nonjudgmental care from a large multidisciplinary team, in a comfortable and busy space, as well as satisfaction with discharge planning, especially when linked to community supports.²³ In another study, examining experiences of Black patients in a locked SSCU in the US (N = 11), the authors reported themes of criminalization, vulnerability, stigma, mismatches between expected and received care, and inequities related to race, ethnicity, and socioeconomic status, particularly during transport and admission processes.²² The cross-sectional observational study measured levels of compassion fatigue and compassion satisfaction in nurses working at SSCUs across 8 hospitals in South Africa.²⁴ Overall, the nurses reported moderate compassion satisfaction, moderate burnout, and high secondary traumatic stress.²⁴

Implementation Considerations

Across the included studies, successful implementation of SSCUs was reported to be supported by close collaboration and integration of units with hospital and community services, clear admission criteria, and structured care planning to facilitate patient flow and discharge.^20,23 Broad admission criteria were associated with longer LOS and increased bed occupancy.²⁰ Some units reassigned existing staff, reducing set-up costs.²¹ Locating the unit close to the ED could increase inappropriate referrals but also provide opportunity for improved communication between teams.³ Delivering trauma informed, culturally sensitive, and individualized care was identified as critical while restrictive practices (i.e., restraints) and law enforcement involvement were reported to negatively impact patient experience, particularly among racialized groups.²²

Limitations

Methodological Limitations

This Environmental Scan aimed to provide an overview of some SSCUs operating across Canada rather than a comprehensive inventory of all SSCUs. We did not receive responses (or received ineligible responses based on our SSCU definition) from 6 jurisdictions in Canada nor from all operating SSCUs in the jurisdictions who did respond, resulting in gaps in the data and results. Some people who responded to the survey may not be aware of, or have access to, the information sought in the survey, and therefore, the results may not be entirely accurate or representative of the current landscape of SSCUs in Canada. We did attempt to mitigate this limitation by using purposive sampling and snowballing techniques to distribute the survey to those most knowledgeable about SSCUs. These sampling methods themselves; however, introduce the risk of sampling bias.

While we use the term “short-stay crisis unit” in this report, there are numerous names that may be used to refer to services that fit the same definition (e.g., behavioural assessment unit, psychiatric observation unit), so there is a possibility that this report is missing some relevant information sources that use alternative names. We tried to mitigate this risk by searching for different terms in the literature. Furthermore, only English-language studies were included. The intention of this report was to provide an overview of the type of literature that is available on the topic of SSCUs, rather than to comprehensively explore the safety and effectiveness results. Given the nature of the study designs appropriate for this topic, we anticipate that study quality assessments guided by standard appraisal tools would result in a “low quality” rating due to unavoidable biases, even though studies may be well designed. We did not perform a critical appraisal of the included studies however and therefore cannot comment on the risk of bias or certainty of the evidence. Finally, a single reviewer screened the studies and extracted data which may increase the risk of error and bias in study selection and data extraction. No evidence was found exploring the specific needs of those who are unhoused or Indigenous populations.

Generalizability

Due to the size and variability of jurisdictions in Canada, the findings of this survey may not be applicable to the needs of all communities. Most SSCUs represented in this survey served only adults, and therefore the evidence may not be applicable to SSCUs meant for pediatric patients. Similarly, we received responses from SSCUs that largely serve urban or suburban populations. Jurisdictions in Canada consist of many rural and remote populations, and these were not represented in this report. The studies included in this report took place across a variety of locations including Australia, France, South Africa, the UK, and the US. However, because none of these studies were conducted in Canada, differences in patient populations, ED workflows, and community mental health resources, may limit the generalizability of this evidence to settings in Canada.

Conclusions and Implications for Decision-Making

Summary of Evidence

This Environmental Scan aimed to provide an overview of both the components and experiences of SSCUs in Canada and the available literature on their safety and effectiveness for patients experiencing mental health crises. A survey of jurisdictional contacts and a search of published and unpublished literature were conducted.

The survey results summarized in this report suggest considerable heterogeneity in the names, models of care, referral pathways, capacities, and staffing of SSCUs across Canada. For example, the number of beds available ranged from 2 to 21, and full-time equivalent staff ranged from 3 to 40. All units were open 24 hours a day, 7 days a week, no fees were charged to the patients, and the units were funded by either their ministry of health, the hospital, or a combination of both. Most units served only adults and reported a goal LOS of 72 hours but noted that this was flexible depending on the case. All those who responded to the survey indicated benefits from SSCUs included providing a safe space for patients experiencing crisis to stabilize and be referred to community, while also avoiding unnecessary and sometimes harmful inpatient admissions. Common challenges included securing stable funding, suitable physical space, and appropriate staff. Operationally, some people who responded noted difficulties with SSCU beds being reassigned to patients receiving acute care when ED volume was high, a lack of understanding from ED staff on the unit’s purpose and admission criteria, and limited community resources for appropriate discharge planning.

Our literature search identified 7 relevant publications. Overall, the authors of these publications indicated that SSCUs appear to improve ED LOS while reducing the use of restraints.

Considerations for Future Research

Given the limited availability of studies conducted in Canada, future research could evaluate whether SSCUs improve clinical and health system outcomes within publicly funded health care settings. Outcomes of interest might include the number of inpatient psychiatric admissions, ED LOS, and patient-reported experiences of care. Research could also examine whether these models provide equitable access and benefit across diverse populations prevalent in Canada, including women, racialized groups, people experiencing homelessness, Indigenous Peoples, people with lived experience of substance use, and those living in rural and remote communities. Community partnerships and follow-up pathways that optimize outcomes beyond the initial SSCU visit could also be assessed.

Implications for Decision-Making

Potential implementers of an SSCU may wish to reflect on the composition of the population the unit is intended to serve. Structural barriers to the access and quality of mental health care services in Canada have been documented for certain groups including women, racialized groups, Indigenous Peoples, people with lived experience of substance use, and people experiencing homelessness.⁸ If 1 or more of these populations make up a substantial portion of those presenting to the ED with mental health or substance use concerns, SSCUs should be prepared to provide appropriate care. This could include relevant staff training, for example, the presence of an Indigenous Elder or strong relationships with supportive housing organizations. While locked units and the use of restraints can provide a level of security, 1 included study noted that this may negatively impact patient experience, particularly among racialized groups.²²

Decision-makers and clinicians planning to implement an SSCU may wish to ensure the unit is equipped to support patients with mental health concerns as well as those experiencing substance use or addiction-related issues. These patients may require medical clearance before transfer to the SSCU. Where detoxification or withdrawal management is expected to occur within the unit, appropriate medical equipment (e.g., IV therapy capabilities) and staff with relevant clinical expertise may be needed. Some people who responded to the survey also identified the value of a dedicated addictions liaison team to support treatment and discharge planning for this population. Decision-makers should consider how the needs of patients with substance use and addiction concerns will be safely and effectively addressed within the SSCU model.

Almost all of the people who responded to the survey indicated that their SSCU fits within a broader “stepped care” model of mental health care in the community, serving as both a diversion from inpatient psychiatric admission and a transition to community-based care. Decision-makers who intend to implement an SSCU may wish to consider what other mental health resources (e.g., supported housing, addiction services, peer support programs, outpatient psychiatry) are available in their jurisdiction to support the implementation of an SSCU. One person who responded noted that a facilitator to the implementation of their unit was the involvement of experts, community, and those with lived experience in the planning stages. The development of services that follow up with patients after discharge, as is the case for a planned unit in Prince Edward Island, or the collaboration with outpatient day programs, as in a unit in British Columbia, are something to consider.

Relatedly, to properly serve the appropriate acuity of patients, it is suggested that beds be reserved for those eligible for the SSCU. Strict and clear admission criteria and referral pathways, and clear communication between the general staff in the ED and the SSCU can contribute to this goal. A local assessment of the number of eligible visits may help guide the number of beds needed. These factors, along with 24 hours, 7 days a week operating hours, have the added benefit of ensuring that patients are transferred quickly from the general ED to the SSCU, which is another important contributor to successful treatment.

Finally, appropriate and consistent staffing is integral to the successful implementation of a SSCU. This includes ensuring adequate support from staff with relevant expertise, such as psychiatrists, registered nurses, and social workers, as well as fostering effective teamwork, proactive patient engagement, and a shared culture of care. Decision-makers may wish to consider both preimplementation and ongoing staff training. For example, at the safe observation and assessment unit in Edmonton, Alberta, training is delivered by physicians from a local day hospital program, simultaneously building staff capacity and strengthening relationships with an important community partner.

The limitations of this Environmental Scan, such as the variability in terminology and models of care of included SSCUs and concerns regarding the generalizability of findings to settings in Canada, should be considered when interpreting the conclusions of this report. Despite this, the findings can serve as a starting point for jurisdictions that may wish to implement or make changes to SSCUs.

Acknowledgements

The authors would like to thank the following content experts who provided feedback throughout the project and who externally reviewed this document. They have granted permission to be cited.

Grace MacEwen, BScN, RN

Clinical Supervisor, Health PEI

Mark Corie, MD, FRCPC

Psychiatrist, Royal Alexandra Hospital

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Appendix 1: Detailed Findings

Please note that this appendix has not been copy-edited.

Survey Findings

Table 4: Type of Staff at SSCUs in Canada

NR = not reported; SSCU = short-stay crisis unit.

Literature-Based Findings

A total of 452 citations were identified in the electronic database searches. Following screening of titles and abstracts, 411 were excluded, and 40 potentially relevant articles were retrieved for full-text review. Of these articles, 8 met the inclusion criteria and were included in this report.

Table 5: Key Characteristics of Included Studies

APEU = Adolescent Psychiatric Emergency Unit; ED = emergency department; EE = economic evaluation; ITS = interrupted time series; KPI = key performance indicator; LOS = length of stay; MHT = mental health trust; NA = not applicable; NHS = National Health Service; PANDA = Psychiatric, Alcohol and Non-Prescription Drug Assessment; PDU = psychiatric decision unit; PEU = psychiatric emergency unit; RE-AIM = reach, effectiveness, adoption, implementation, and maintenance; RN = registered nurse; ROI = return on investment; SARA = stabilization and referral area; SR = systematic review; UPSAM = Unité Psychiatrique Sarthe Anjou Mayenne.

^aAll costs reported in 2019-2020 British Pound prices, with costs taken from the NHS’ National Schedule of Unit Costs and from the annual Unit Costs of Health and Social Care.

Appendix 2: Detailed Methods

Please note that this appendix has not been copy-edited.

Literature Search Methods

An information specialist conducted a literature search on key resources including MEDLINE, PsycInfo, the Cochrane Database of Systematic Reviews, the International Health Technology Assessment (HTA) Database, the websites of HTA agencies in Canada and major international HTA agencies, as well as a focused internet search. The search approach was customized to retrieve a limited set of results, balancing comprehensiveness with relevance. The search strategy comprised both controlled vocabulary, such as the National Library of Medicine’s MeSH (Medical Subject Headings), and keywords. Search concepts were developed based on the elements of the research questions and selection criteria. The main search concept was SSCUs. The search was completed on December 12, 2025, and limited to English-language documents published since January 1, 2015.

Selection Criteria and Methods

One reviewer screened citations and selected studies. In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved and assessed for inclusion. The final selection of full-text articles was based on the inclusion criteria presented in Table 4.

Table 6: Criteria for Literature Screening

ED = emergency department; LOS = length of stay; NA = not applicable.

Exclusion Criteria

Articles were excluded if they:

• did not meet the selection criteria outlined in Table 6

• were duplicate publications or were published before 2015

• were SRs in which all relevant studies were captured in other more recent or more comprehensive SRs

• were primary studies captured in 1 or more included SRs.

Data Extraction

One reviewer extracted data directly into standardized tables created in Microsoft Word, which were modified as necessary. The extracted information included study characteristics, methodology (e.g., study design), population, intervention, comparator, and results regarding the outcomes of interest.

Engagement Approach

The CDA-AMC engagement team began outreach in December 2025. The primary purpose of engagement was to identify a content expert with administrative and operational knowledge of, and experience, working at an SSCU in Canada to review the draft survey and provide input to ensure clinical relevance. A second content expert was identified to serve as a peer reviewer. The project team identified potential experts through academic and grey literature and existing contacts through CDA-AMC. Project details, and the engagement opportunities, were shared with content experts by email or through teleconference. Each content expert who agreed to participate gave informed consent and completed a conflict of interest form and were provided with compensation for their work at the standard rate issued by CDA-AMC.

From December 2025 to March 2026, the project teams continued to identify and reach out to potential interested parties or individuals with administrative and/or operational expertise at an SSCU. The project team reached out to existing contacts to advise them about the project the survey and to answer any questions.

A draft version of the report was posted on the CDA-AMC website for public review and feedback from May 20, 2026, to June 3, 2026. All individuals originally contacted were advised of the feedback opportunity via email. Participants who responded to the survey were contacted to ensure responses were summarized correctly.

Survey

We conducted a survey to identify SSCUs that previously operated, are currently operating, or are being planned across Canada. The survey comprised 39 questions, which explored multiple aspects of SSCUs, including structural components, operational components, and implementation and evaluation considerations. The questions were both open-ended and closed-ended and are presented in Appendix 3, Table 7. A content expert reviewed the survey and project team members reviewed and piloted the survey, which was distributed using Alchemer. Both English and French versions of the survey opened on March 17, 2025, and we collected responses until April 10, 2025. We distributed the survey electronically to jurisdictional contacts.

We used purposive sampling to identify those who responded to the survey and who were the most likely to be able to provide survey responses, which included managers, directors, administrators, and staff familiar with SSCUs in Canada. We identified these contacts through members of the Health Technology Expert Review Panel, expert members involved in related earlier work through CDA-AMC (i.e., ED overcrowding, urgent care centres), engagement team networks through CDA-AMC, and internet searching. We made an effort to have representation from as many jurisdictions in Canada as possible by reaching out to contacts in each jurisdiction with at least 1 known SSCU. We used a snowball sampling approach to identify individuals who were knowledgeable about SSCUs who were not on our original contacts list, by indicating in the survey invitation that contacts had the option to share the survey with their contacts. We sent 1 email reminder to those who did not respond to the survey 1 week after the initial invitation. All who responded provided explicit permission to use the information that they provided in this report. Information about the people who responded to the survey is outlined in Appendix 4, Table 8.

External Review

Peer Review

Before the review phase began, 1 clinical expert with expertise in emergency psychiatric nursing reviewed the project plan. This same expert, and another with expertise in psychiatry and the operation of an SSCU, reviewed the draft version of this report, and their feedback was incorporated into the final version of this report.

Selection of Included Studies

Figure 2 presents the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)²⁵ flow chart of the study selection.

Figure 2: Selection of Included Studies

Appendix 3: Survey Questions

Table 7: Survey Questions

Appendix 4: Information on Survey Respondents

Table 8: Information on Survey Respondents

^aSurvey response pertained to a different model of psychiatric emergency care (not a short-stay crisis unit) so was excluded from the main findings and tables of this report. Instead, the details provided are summarized in the Other Models of Psychiatric Emergency Care section.

Appendix 5: References of Potential Interest

CADTH. Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions. Published November 2023.

Centre for Clinical Effectiveness. Models of care for mental health in ED: scoping review. Centre for Clinical Effectiveness, Monash Innovation and Quality, Monash Health; 2017. https://monashhealth.org/wp-content/uploads/2019/01/Models-of-Care-ED_Mental-Health_Scoping-Review2017_FINAL.pdf

Facility Guidelines Institute. Design of behavioral health crisis units. June 2022. https://fgiguidelines.org/wp-content/uploads/2022/06/FGI-Design-of-BHCUs_2022-06.pdf

Mitchell D, Bressington D. An Evaluation Protocol for A Stabilisation and Referral Area (SARA): A Novel Short Stay Psychiatry Unit Serving A Remote Region of Australia. Alpha Psychiatry. Apr 2025;26(2):39448. doi:10.31083/AP39448.