A specialized approach to mental health crisis care at HUP–Cedar in Southwest Philadelphia

Someone is revived after a drug overdose but is frightened, confused, vomiting, shaking, and desperate to avoid falling back into addiction.

Another has cycled repeatedly through emergency department visits, homelessness, and substance use relapses, and needs stabilization and connection to longer-term care.

Yet another is brought by police at the urging of family after their behavior has become a danger to themselves or others.

These are different crises, but they share a common reality: the need for immediate, specialized care in a setting equipped to respond.

A mental health crisis rarely arrives in a form that feels orderly. For patients and their loved ones, it can mean fear, confusion, escalating symptoms, and urgent questions about where to turn for help. Too often, hospital emergency departments become that entry point, even though they are not always designed to provide the specialized, therapeutic environment that psychiatric crises require.

At the Hospital of the University of Pennsylvania – Cedar Avenue, Penn Medicine’s newest crisis response center offers another path: a 24/7 walk-in setting built specifically for rapid psychiatric assessment, stabilization, and connection to ongoing support. Three years after opening, the center reflects a broader Penn Medicine effort to get patients the right care in the right place, while deepening access to psychiatric services in West and Southwest Philadelphia.

Nationally, mental health–related visits account for more than 5,000 per 100,000 emergency department encounters, according to the Centers for Disease Control and Prevention.

At the same time, psychiatric emergencies frequently involve extended waits for appropriate placement. Studies show that more than one in five psychiatric emergency visits include “boarding,” or periods when patients remain in the ED after being evaluated while awaiting inpatient or specialized care. These stays often last six hours or more, and can extend significantly longer, reflecting ongoing constraints in inpatient capacity and community-based services.

Against that backdrop, crisis response centers like HUP–Cedar and its companion CRC at Pennsylvania Hospital have emerged as one approach to improving how patients access and move through mental health care, offering rapid assessment, stabilization, and connection to ongoing support in a setting designed specifically for emergency psychiatric care.

In that sense, the HUP–Cedar CRC represents both continuity and change. It’s a return of crisis mental health services to a site where, a few years earlier, the hospital building’s previous owner closed a previous CRC under financial pressures. And the CRC now reestablished within Penn Medicine’s Penn Medicine’s broader network of psychiatric care and shaped by the needs of the surrounding community.

This type of care presents unique challenges, as well as opportunities to build a thoughtful, community-focused setting, according to Stephanie Hollister, MSN, RN, AVP of Behavioral Health for the HUP–Cedar CRC, who stepped into her role as the center opened.

Hollister said the CRC sees a wide range of patients: people with substance use disorder, people who have interacted with police and may also be experiencing a mental health condition, individuals with intellectual disabilities living in residential settings, and people whose long-standing mental illness has worsened after missed appointments, transportation barriers, or loss of family support.

“So, we do what we can to help connect them to support in the community,” Hollister said.

Psychiatric leaders say that model continues to evolve as they think about how crisis services can better connect patients to treatment.

“One area we are really interested in is the idea of mental health urgent care, where patients can actually begin treatment when they arrive,” said Katie Dalke, MD, MBE, the Benjamin Rush Associate Professor in Clinical Psychiatry and Vice Chair for Clinical Operations in Psychiatry. “Whereas at a CRC, the model is less about starting treatment and more about connecting patients to treatment elsewhere in the system.”

Even within a short-term stabilization model, the experience of care matters. Dalke pointed to intentional design choices such as a nurse’s station with open sightlines that support openness, visibility, and de-escalation, elements meant to make the CRC feel more therapeutic and less chaotic than a traditional emergency setting.

“It was done very intentionally, drawing on past experience while balancing patient and family comfort with provider and patient safety,” she said.

That community-centered philosophy is even visible in artistic choices in the space. A mural of the Philadelphia skyline greets patients inside the inpatient unit. It’s an intentional reminder that even in moments of acute crisis, care should feel grounded in dignity, familiarity, and connection to the community outside its walls.

In its first three years, the HUP–Cedar CRC has become a key access point for mental health care in Philadelphia, helping reshape how patients enter and move through psychiatric care.

• Faster path to specialized care: Patients can be evaluated and stabilized in a matter of hours in a setting designed specifically for mental health, rather than waiting extended periods in a traditional emergency department. Dalke said emergency encounters across Penn Medicine’s two CRCs increased after HUP–Cedar opened, suggesting previously unmet need.
• Relief for crowded emergency departments: By diverting patients from the ED, the CRC helps ensure people in mental health crisis receive more specialized care while freeing emergency resources for medical needs. This aligns with a broader array of efforts across Penn Medicine to get patients the right care in the right place.
• Stronger pathways across Penn Medicine and community-based support: A central focus of the CRC model is what happens after discharge: linking patients to outpatient care, substance use treatment, and community-based services. For example, Dalke noted, staff have been able to connect Cedar patients to care only available at Pennsylvania Hospital—like electroconvulsive therapy—and patients at Pennsylvania Hospital with resources only available at Cedar, such as detox, all within Penn Medicine.

Hollister is candid about persistent misconceptions, including the idea that every difficult interaction is automatically a mental health issue—and emphasizes that mental health conditions deserve the same clinical respect as any other medical concern.

“If you had high blood pressure, nobody would blame you,” she said. “We would treat it. We would support you. It should be the same.”

Dalke also emphasized the role stigma plays in shaping how psychiatric care is understood, and how intentionally Penn has tried to approach that care.

“The nature of stigma in psychiatric illness is that, by and large, there isn’t a clear or consistent understanding of what quality care for acutely ill patients is,” Dalke said.

Dalke added that a significant function of a CRC is also about public safety.

“How do you make this a therapeutic experience for a person for whom this is the first encounter they've ever had with the [psychiatric care] system? Or maybe they have been having bad experiences with the system and this is our opportunity to re-engage them,” Dalke said.

Even with intentional design, specialized staffing, and coordinated systems, emergency mental health care remains both complex and deeply human.

For example, Dalke noted, if someone arrives at the CRC on a 302—an involuntary psychiatric hold where law enforcement or physicians mandate emergency psychiatric evaluation and treatment for an individual who is deemed a danger to themselves or others, the decision can have lasting implications.

“That designation means someone may no longer be able to serve in the military, among other consequences,” she said. “You’re making decisions that directly impact a person’s dignity. It can feel antagonistic to the patient, but if you spend even a couple of hours in the CRC, you see how skilled the nurses and technicians are at helping patients maintain a sense of control and dignity, even in crisis.”

The example underscores both the power imbalance that can exist in crisis care and the skill required to deliver that care.

As Philadelphia continues to confront overlapping mental health and substance use challenges, the HUP–Cedar CRC offers a case study in what crisis care can look like when it is specialized, connected, and community-rooted. Three years in, its significance lies not just in the fact that it exists, but in what it represents: a more humane front door to care for people at some of the most vulnerable moments of their lives.