A woman is discharged from the emergency room after a suicide attempt, given a list of phone numbers and told to follow up with her doctor. She goes home to the same apartment where she tried to end her life, the same problems that felt unsolvable before, the same emptiness. The phone numbers sit on her counter. She does not call them. Two weeks later, she is back in the emergency room. A man leaves a crisis stabilization unit after seventy-two hours, his acute psychotic episode managed by medication, his immediate danger passed. No one has scheduled a follow-up appointment because the outpatient clinic has a three-month wait. He has pills to take and instructions to follow, but he goes home alone to figure out how to restart a life that was interrupted by crisis. A teenager discharged from psychiatric hospital returns to the school where she was bullied, the friend group that excluded her, the social media that amplified her pain. Her hospitalization addressed her crisis but nothing in her environment has changed. A family receives a call that their adult son has been discharged from the hospital after a manic episode, but they were not involved in discharge planning and do not know what medications he is taking or what to watch for. The period after mental health crisis is among the most dangerous and most neglected phases of care. What happens in the days and weeks after crisis intervention often determines whether the crisis was a turning point or just another episode in an ongoing cycle.
The Case for Systematic Follow-Up Care
Advocates for systematic follow-up argue that the post-crisis period is when intervention matters most and that structured follow-up should be standard. From this view, crisis resolution without follow-up is incomplete care.
The post-crisis period is high-risk. Suicide risk is highest in the days and weeks after discharge from psychiatric hospital or emergency room. Relapse to substance use often occurs soon after detox or crisis intervention. The crisis was a warning; the follow-up period is when that warning is either heeded or ignored.
Continuity of care improves outcomes. When someone in crisis is connected to ongoing care rather than discharged to a waiting list, outcomes improve. The relationships and momentum from crisis intervention should continue into follow-up. Transition from crisis to ongoing care should be seamless.
Systematic follow-up can be implemented. Protocols for post-crisis contact, scheduled appointments before discharge, warm handoffs to community providers, and bridging services during transition are all achievable. The gap between crisis and ongoing care is policy choice, not inevitable.
From this perspective, improving post-crisis care requires: mandatory follow-up contact within specified timeframes; appointments scheduled before crisis discharge; warm handoffs between crisis and ongoing services; bridging services for the transition period; and accountability for post-crisis outcomes.
The Case for Community Capacity Building
Others argue that follow-up requirements without community capacity to receive those followed up does not solve the problem. From this view, building community services is more important than mandating follow-up.
Follow-up to nonexistent services is meaningless. Requiring crisis services to schedule follow-up appointments when outpatient services have three-month waits does not provide care. The problem is not lack of follow-up protocols but lack of services to follow up with.
Placing follow-up responsibility on crisis services may burden them without addressing root causes. Crisis services already struggle with capacity. Adding accountability for follow-up may not be appropriate when they cannot control community service availability.
Investment in community mental health capacity would reduce the gap that follow-up requirements attempt to bridge. If people could access ongoing care when they need it, the crisis-to-care transition would not be the problem it is. Build the services rather than mandate transitions to services that do not exist.
From this perspective, improving post-crisis outcomes requires: substantial investment in community mental health capacity; reduced wait times for ongoing services; community services that can absorb people leaving crisis; and recognition that follow-up protocols cannot substitute for service availability.
The Transition Period Risk
The period between crisis resolution and engagement with ongoing services is particularly dangerous.
From one view, transition period interventions are essential. Bridging services, frequent contact, and intensive support during this vulnerable time prevent the worst outcomes. Investment in transition specifically is warranted.
From another view, the transition period would not be so dangerous if ongoing services were available. Creating special transition services patches a problem that should not exist. Fix the service gap rather than creating services to bridge it.
How the transition period is addressed shapes intervention strategy.
The Contact Models
Various models for post-crisis contact have been developed.
From one perspective, active outreach should be standard. Caring contacts, phone calls to check in, and home visits demonstrate concern and catch problems early. Waiting for people in crisis to call back is not adequate. Reaching out saves lives.
From another perspective, contact protocols must respect autonomy. Not everyone wants to be contacted. Intrusive follow-up may feel controlling. Contact should be offered, not imposed.
What contact approaches are appropriate shapes follow-up design.
The Suicide Attempt Follow-Up Specifically
Follow-up after suicide attempts deserves particular attention given the risk.
From one view, suicide attempt follow-up should be mandated and intensive. The period after attempt is highest risk for another attempt. Every person who attempts suicide should receive structured follow-up regardless of system capacity constraints. Lives are at stake.
From another view, mandate without resources creates unfunded obligation. Suicide follow-up should be prioritized but must be achievable. Realistic protocols given available resources may serve better than mandates that cannot be met.
How suicide attempt follow-up is structured shapes prevention.
The Family Involvement Question
Involving families in post-crisis care can improve outcomes but raises confidentiality concerns.
From one perspective, family involvement should be standard unless patient refuses. Families provide support, notice warning signs, and can ensure follow-up occurs. Discharge planning should include family.
From another perspective, family involvement should be patient choice. Some families are harmful. Adults have right to confidentiality. Family involvement should be offered and encouraged but not assumed.
How families are included in post-crisis care shapes support systems.
The Peer Support Role
Peer support workers can provide post-crisis connection.
From one view, peer support is particularly valuable during post-crisis transition. Someone who has experienced crisis and recovery can offer hope and understanding that professionals cannot. Peer follow-up should be available.
From another view, peer support is one option among many. Not everyone connects with peer support. Professional follow-up should not be replaced by peer support. Both should be available.
What role peers play in post-crisis care shapes support options.
The Safety Planning Importance
Safety plans created during crisis should be activated during follow-up.
From one perspective, safety plan follow-through is essential. Plans created during crisis mean nothing if not reviewed and used during follow-up. Follow-up should include safety plan review and reinforcement.
From another perspective, safety plans are tools for individuals, not follow-up protocols. People should have and use their plans regardless of system contact. The plan is theirs to use, not something done to them.
How safety plans relate to follow-up shapes their role.
The Technology Options
Technology may enable follow-up that face-to-face contact cannot achieve.
From one view, text, apps, and telehealth can extend follow-up reach. People who will not answer phone calls may respond to texts. Apps can prompt check-ins and provide coping tools. Technology should be embraced for follow-up.
From another view, technology is not relationship. Automated contacts may feel impersonal. Technology should supplement rather than replace human connection. Post-crisis care requires human relationship.
What role technology plays in post-crisis follow-up shapes how it is delivered.
The Environment Return Problem
People often return to the same environments that contributed to their crisis.
From one perspective, follow-up must address environmental factors. Returning to abusive relationships, housing instability, or other contributors to crisis will produce another crisis. Post-crisis care should include environmental intervention.
From another perspective, crisis services cannot solve environmental problems. They can provide referrals to housing, domestic violence, and other services. Expecting crisis follow-up to address housing and social problems is unrealistic.
Whether environmental factors are part of post-crisis care shapes intervention scope.
The Canadian Context
Canadian provinces have varying approaches to post-crisis follow-up, with some implementing structured follow-up programs and others leaving follow-up to individual provider discretion. Wait times for outpatient services often create gaps between crisis and ongoing care. Standards for post-crisis follow-up are inconsistent.
From one perspective, Canada should establish post-crisis follow-up standards and ensure services exist to provide follow-up care.
From another perspective, investment in community service capacity is prerequisite for meaningful follow-up requirements.
How Canada addresses post-crisis care shapes outcomes for those who survive crisis.
The Question
If the period after mental health crisis is when risk is highest, if people discharged from crisis services often return to crisis because nothing changed, if systematic follow-up can reduce bad outcomes - why is post-crisis care so often inadequate? When someone attempts suicide, is discharged from the emergency room with a list of phone numbers, and attempts again before any follow-up contact occurs, whose failure is that? When crisis services provide excellent immediate care and then discharge people to communities without capacity for follow-up, what has the crisis care actually accomplished? When we invest in crisis response but not in what comes after crisis, what does that investment pattern reveal? And when people cycle through crisis repeatedly because no one connected crisis to ongoing care, what does that cycle tell us about our mental health system?