Symptoms, circumstances, and service systems: Pathways to psychiatric crisis service use among uninsured young adults

Sarah Carter Narendorf, Michelle R. Munson, Micki Washburn, Nicole Fedoravicius, Richard Wagner, Sara K. Flores

Research output: Contribution to journalArticlepeer-review


Young adults have low rates of outpatient service utilization and higher rates of emergency service use compared to older adults. This study explored pathways to crisis service use for uninsured young adults who accessed emergency psychiatric treatment. Participants were 55 young adults (ages 18-25) who were on an inpatient short-term stabilization unit and had qualifying diagnoses for outpatient services (bipolar, major depression, or schizophrenia). Semistructured qualitative interviews were conducted to understand decision-making and the events that led to service use. A team of coders used an open coding approach to develop a codebook and participated in iterative discussions of coded text to generate results presented. Themes across 3 dimensions were identified. Participants formed the intention to seek treatment through the interaction of escalating symptoms, triggering events, and motivating factors. Intention was translated to actualized service use through individual and systemic facilitators. Natural supports and service systems influenced the entire process. Findings highlight the importance of understanding motivating factors to better engage young people in treatment and including their support systems in efforts to increase awareness of problems and treatments. Systemic barriers identified suggest the need for enhanced coordination of care across systems such as drug and alcohol treatment, homeless services, and criminal justice and for ready access to outpatient services to reduce crisis psychiatric service use.

Original languageEnglish (US)
Pages (from-to)585-596
Number of pages12
JournalAmerican Journal of Orthopsychiatry
Issue number5
StatePublished - 2017


  • Emergency services
  • Mental health treatment
  • Psychiatric crisis
  • Psychiatric disorders
  • Young adult

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Arts and Humanities (miscellaneous)
  • Psychology (miscellaneous)
  • Psychiatry and Mental health


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