Accessing Psychiatric Emergency Services Programs (ESP)

Overview of Emergency Services

Psychiatric Emergency Service teams, also known as ESP’s (emergency service program), provide crisis assessment, intervention and stabilization services for both mental health and addiction-related emergencies. Services are available 24 hours a day, 7 days a week, 365 days a year. The goal of ESP’s, whenever possible, is to help individuals avoid a lengthy hospital emergency room visit by offering community-based alternatives for psychiatric crises, in which individuals and/or families can be seen in more comfortable and less stressful environments.  In general, in-person crisis interventions can be provided at ESP office locations, schools, homes, residential facilities, and other community settings. In more acute situations regarding imminent risk of safety or complicated medical issues, ESP teams will also evaluate clients in their local hospital emergency rooms.

Who qualifies for ESP services?

All individuals, regardless of age, demographics, disabilities, etc., are eligible to utilize ESP services, and evaluations may be provided in the office of the Emergency Service Provider, or in the local Emergency Room, depending on the acuity of the presenting concerns. ESP services are covered by most insurance plans, including all MassHealth (Medicaid) and Medicare plans, as well as people without insurance. Most commercial insurance companies also have contracts with ESPs, though coverage may vary between these plans.

Children and youth up to age 21 who are enrolled in any MassHealth “coverage type” (with the exception of the “limited” type) are also eligible to receive Mobile Crisis Intervention. This is a short-term (up to 72 hours) mobile, on-site, face-to-face crisis intervention. An emergency service provider will attend to the child in any setting where the child is located in their community. The clinician will additionally follow up with the youth or caregiver of the youth for up to seven days after the evaluation. This is contingent on the disposition plan (i.e. more intensive level of care: inpatient, CBAT and detox do not require a follow up) and whether the caregiver and/or youth (ages 18-21) arrange additional follow-ups.

The state of Massachusetts is divided into 21 catchment areas which cover every town throughout the state. One Emergency Service Provider or team is assigned for each catchment area. To find out what catchment area and team covers your town, you can consult an online list for the whole state, or call the statewide ESP toll-free number, 877-382-1609 and enter your zip code to find out which team covers your area.

What to expect when calling ESP for an adult, child, or adolescent?

A clinician or family partner on the ESP team, who has expertise in crisis intervention, will pick up the phone and ask your reason for calling. S/he is committed to providing you with the necessary support and resources to ensure you or your family member receives the support that is needed. S/he will ask you a series of questions to determine the nature of the emergency you are experiencing, and will be assessing early on the best place for you or your family member to be evaluated. Should the clinician believe you are in imminent danger of hurting yourself or others, s/he will direct you to the nearest emergency room, and/or may prompt you to contact the police. If you are not in imminent risk of safety but are in active crisis, the clinician will schedule an appointment with you to administer an evaluation at the nearest ESP office.  The purpose of the ESP clinician is to respond rapidly, assess effectively, and provide early intervention to help individuals and their families who are in crisis, ensuring their safety and the appropriate level of care to meet the individual's’ needs.

Could I participate in the intervention as a parent, guardian and/or caregiver?

Yes, crisis intervention requires flexibility in the duration of the initial evaluation, the person’s participation in the treatment, and the number and type of follow-up services. It is crucial that the individual, his/her family or other primary caretakers/guardians, and natural support systems participate in the crisis intervention process whenever possible. The provider will determine what level of care is appropriate for you and/or your child and will consult with you regarding recommendations for treatment before making arrangements for the appropriate level of care (e.g. inpatient, CBAT, detox).

How do I know if I or my child needs a crisis evaluation?

The caller, who may be the individual in crisis, his/her family member, or another supportive person must believe that an individual is in an active state of crisis, which generally means that the person is at risk of either hurting themselves or someone else. For an ESP, at least one of the following would be a reason for an evaluation:

  • The individual or child demonstrates and/or collateral contact(s) report information that represents risk to self and/or others.
  • The individual demonstrates and/or collateral contact(s) reports an incapacitating or debilitating disturbance in mood/thought/behavior that is different from their typical level of functioning in these areas.
  • The mental health symptoms are disruptive to interpersonal, familial, occupational, and/or educational functioning to the extent that immediate intervention is required.

In addition, the evaluator must reasonably expect that an intervention will either improve or stabilize the individual’s condition and resolve the crisis safely in the community, or that it will determine that a more intense course of treatment is immediately necessary and arrange for treatment at the appropriate level of care.

The ESP also identifies services and alternatives that will minimize distress and aid in crisis stabilization. Referrals and coordination of services are provided to link individuals and their families with other service providers and community supports that can assist with maintaining maximum functioning in the least restrictive environment.

What if I do not speak English?

The individual being served should have the opportunity to receive an assessment and the appropriate services in his or her primary language. Assessment findings should be considered in the context of his/her ethnicity and culture. Cultural and linguistic factors are considered when making level-of-care decisions, and are accommodated whenever possible.

What information is collected during an evaluation?

Below is some information that may be asked during an evaluation. Keep in mind that you have a choice in deciding which questions you feel comfortable answering.

  • Demographic information such as your name, address, date of birth, your relationship to the caller if you are not the person seeking assistance, and the individual’s school or job
  • What is happening right now that is leading you to call, how long it has been going on, and anything that is happening that is making the problem more significant right now
  • What are some of the symptoms or behaviors that either you or the person you are calling about are experiencing that are related to your concerns?  For example, changes in eating, sleeping, relationships with family or friends, or other behaviors that are concerning. This could also include questions about your or your family member’s ability to do things for everyday living such as basic hygiene or being able to go to work or school.
  • Current and past suicidal/homicidal ideation/plan/intent/means
  • History of substance use, including current and past use, any current withdrawal symptoms if appropriate, previous treatment, and any history of relapse
  • Previous and current mental health treatment, and if appropriate, recurrence of previously managed symptoms.  You may also be asked about treatment progress if you or your family member are already receiving mental health services.
  • Medical history, including recent surgeries, allergies, history of head injuries, medicine related medical problems, as well as any medical problems that are related to psychiatric symptoms or behaviors.  The evaluator will also ask about who you see if primary care and the last time you were seen by them.
  • Current medications, who is prescribing them, compliance with taking as prescribed
  • The involvement of family or other supportive individuals or resources that could be important to assisting in a treatment intervention.
  • Obstacles to treatment, in the past or currently

The information in the article above was drawn from the following sources: