Safe Haven Cafés

Safe Haven Cafés, sometimes called Crisis Cafés, are designated areas on or near a hospital campus that provide a calm, safe alternative to the emergency department for patients experiencing behavioral or mental health needs. They can be housed in sub-acute units, new or repurposed buildings or office spaces, or community clinics. The goal of Safe Haven Cafés is to de-escalate patients experiencing a behavioral or mental health crisis and connect those patients with self-management tools and skills, as well as follow-up resources or treatments. 

Safe Haven Cafés originated in 2014 in Aldershot, England, and were first replicated internationally in Melbourne, Australia, four years later. Since 2018, several Australian states—including New South Wales and Western Australia—have implemented the model as part of their strategies to reduce suicides by improving access to mental health services and expanding ED alternatives for psychiatric patients.

Existing Safe Haven Cafés are typically funded through government block grants and involve ongoing collaboration between hospitals, community partners, nonprofit organizations, and volunteers. 

Salaries and wages for mental health clinicians and peer support workers may comprise more than 90% of recurring operational costs. Other recurring costs include overhead and goods and services, including hot drinks and snacks. Capital investment will largely depend on the location of the Safe Haven Café. Organizations repurposing existing spaces will have substantially lower up-front and recurring investments.

Most Safe Haven Cafés are open only during off-hours that coincide with peaks in psychiatric presentations to the ED. Some locations are testing 24/7 services and virtual models. 

Patients generally access Safe Haven Cafés three ways:

1. Drop-in. Most Safe Haven Cafés are open to the public with few exceptions, including patients needing urgent medical intervention or under the influence of substances. Exclusion criteria vary by location. 
2. ED referral or triage. Most Safe Haven Cafés don’t require referrals, but those still in pilot phase may initially restrict access to curb demand. More commonly, patients who present to the ED are escorted to the Safe Haven Café by a peer support worker or other staff member without a referral.
3. Police department triage. Safe Haven Cafés may also work with police departments to automatically transfer patients to the site.  

The level of care provided at Safe Haven Cafés depends on the number and skill mix of staff. Safe Haven Cafés are typically staffed by hospital or third-party mental health clinicians; peer support workers with lived experience of mental or behavioral health needs; and unpaid community volunteers. Staff most often provide non-clinical services, such as emotional support, self-management skills training, referrals to follow-up specialist or inpatient services, and access to local resources.

Up to 80% of patients return for subsequent visits and bring in other patients by sharing their positive experiences.

Health systems around the world are facing unprecedented demand for emergency services, and psychiatric patients make up a significant portion of this demand. For example, in Australia there were 310,471 ED presentations related to mental health across all public systems between 2019-2020. And in the U.K., 83,500 ED presentations between 2020-2021 were patients with depressive disorder. Emergency departments are often not the most appropriate site of care for patients experiencing a mental or behavioral health need. The hectic environment of an ED may exacerbate mental health conditions and lead to a “dehumanizing” patient experience. 

Safe Haven Cafés are gaining prominence across the U.K. and Australia because they help alleviate capacity pressures by providing a safe, effective option for patients who would otherwise contribute to overwhelming ED demand. These spaces reduce ED presentations and admissions that are related to mental health issues, leading to cost savings for providers. The Safe Haven Café at St. Vincent Hospital in Melbourne, for instance, produced an estimated cost savings of $33,860AUD in 2018 by diverting patients away from the ED.

This model is especially timely given that providers are working to shift access points and services away from the hospital and toward new sites and modalities. Factors driving this push include sustainability pressures caused by increased patient demand, changes in consumer preferences, out-of-hospital payment parity, the rise of flexible staffing models, and the Covid-19 pandemic.