Accessing Psychiatric Emergency Services Programs (ESP)

Overview of Emergency Services

Emergency Service Programs, also known as ESP’s 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, in which individuals and/or families can be seen in more comfortable and less stressful environments.  ESP's will work with the client in crisis to develop a strategy that promotes long term stability in the least restrictive environment possible.  Crisis evaluations can be provided at ESP office locations, schools, homes, residential facilities, and other community settings. When a client is at risk to themselves or others and it is deemed unsafe for an ESP clinician to come out to the home to do an evaluation, ESP teams will also evaluate clients in their local hospital emergency rooms. Anyone may call for assistance regarding a mental health crisis or urgent need for substance use intervention. This includes the individual experiencing the crisis, family members, mental health workers, first responders, physicians or other medical providers, schools, employers, community members, etc.

Who qualifies for ESP services?

  • ESP services are covered by most insurance plans, including all MassHealth (Medicaid) and Medicare plans, as well as people without insurance.
  • Children and young adults up to age 21 who are enrolled in any MassHealth and any form of commercial insurance are also eligible to receive Mobile Crisis Intervention (MCI). 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.
  • 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 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 or at your home.

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.  Many ESP's use translation lines in order for you to be able to communicate with them in your primary language. 

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 be asked about treatment progress if you or your family member are already receiving mental health services.  You may also be asked about any history of psychiatric hospitalizations.
  • 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.
  • Trauma history
  • Obstacles to treatment, in the past or currently

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

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).

ESP's will work with the client and their family to discuss the most appropriate treatment recommendations.  ESP's will never remove a client from their home as all of the referral options that ESP's make are solely recommendations that the client and their family can choose to pursue or not.  However, in some circumstances, when a client is at high risk to harm themselves or others or is too unsafe to remain the community and the client is unwilling to go an emergency room on their own, an ESP clinician will consult with an on-call psychiatrist to determine if a client needs to be brought into an emergency room on a section 12 (involuntary commitment).  

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

For an ESP, at least one of the following would be a reason for an evaluation:

  • The individual or child has thoughts about hurting or killing themselves or someone else.
  • The individual or child's symptoms are disruptive and/or harmful towards themselves or others to the extent that an immediate intervention is required.

ESP's also identify services and alternatives that will minimize distress and help to stabilize a crisis. 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.

Do ESP's provide medication evaluations?

Unfortunately ESP's are unable to provide medication evaluations at their offices.  ESP's can refer clients to various levels of care that can assist with medication management, such as outpatient psychiatry, partial hospital programs (for children and adults), and Community Crisis Stabilization Units (3-5 day overnight placement that provides therapy, case management, therapeutic groups, and medication management for individuals 18+).  If you need immediate medication assistance, ESP's will recommend that you go to your nearest emergency room. 

What are the various levels of care that ESP's can refer to?

FOR ADULTS: ESP's can refer adults to: outpatient therapy/psychiatry, Detox/substance abuse programs or Intensvie Outpatient Programs (IOP's), Partial Hospital Programs, Enhanced Acute Treatment Services for Substance Abuse (EATS), Community Crisis Stabilization Units (CCS), and inpatient hospitalization.

FOR CHILDREN/YOUNG ADULTS: ESP's can refer children/young adults to:

  •  Outpatient therapy/psychiatry
  •  CBHI services (in-home family therapy, intensive care coordination, in-home behavioral therapy, and therapeutic mentoring) 
  •  Partial hospital programs which can last 1-2 weeks and consist of individual/group therapy, case management, and medication evaluation during the day while the client stays at their home overnight.
  •  Community Based Acute Treatment (CBAT)-- 1-2 week unlocked overnight program which consists of individual/family/group therapy and medication management services
  •  Adolescent Enhanced Acute Treatment Services for Substance Abuse (EATS)-- 1-2 week unlocked overnight program which consists of individual/family/group therapy for     adolescents suffering from substance abuse and addiction.
  •  Inpatient hospitalization

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