What makes a city livable? The answer, some say, is more “third places,” spaces distinct from one’s home (the first place) and one’s workplace (the second place). A third place, like a café, park, or library, fosters the sense of community and connection that makes a neighborhood great to live in. This imprecise yet uncomplicated framing effectively refocuses a complex set of social, economic, and urban design issues on a simple solution to the “livability” problem.
I believe that the “third place” framework also can usefully reframe another discipline: emergency mental health care. Individuals experiencing mental health crises lack an appropriate setting to receive care. Typically, individuals experiencing acute, emergency mental health crises-–whether related to substance use or not-–end up in one of two places: the hospital emergency room (ER) or a jail cell. The problem is that neither of these two places is well-equipped to treat someone in the midst of a mental health crisis. A third option is needed.
Emergency rooms are increasingly overburdened by individuals seeking care for mental health and substance use. Despite the fact that fewer than half of emergency departments across the nation provide psychiatry services, the share of ER patients seeking treatment for mental health and substance use has risen sharply. Emergency departments are better suited to treat victims of a car crash or heart attack, and struggle to take on the influx of patients with mental health crises. Further, emergency rooms often fail to connect individuals in crisis to the community resources necessary to address root causes of their distress. The physical environment itself – with bright lights and busy waiting rooms – is not an ideal space for an individual to stabilize. And to make matters worse, people seeking help may leave the facility having racked up a crushing bill for the services they received.
Another place people in crisis all-too-often end up is a jail cell. Police responding to a crisis situation are trained to control the environment. If a person is deemed to be a threat to others, they will be arrested and booked into the local jail. Even if the behavior is attributable to substance use or mental illness, jails are often the only place in a community that can house a potentially aggressive person in crisis. The United States already has the largest incarcerated population in the world – a result of what some call the criminalization of mental health. Even though nearly half of all incarcerated individuals report a history of mental illness, carceral facilities are not designed to provide quality mental healthcare services. On the contrary, jails and prisons often exacerbate mental health issues and provide little or no substance use treatment.
With neither ERs nor carceral facilities functionally addressing the problem, the need for a “third place” is evident. What individuals in crisis could use is a place to sober up, calm down, or generally stabilize. Instead of leaving with crippling debt or a criminal record, individuals visiting a crisis center could be connected to longer-term supports like peer counseling or outpatient care. If an individual’s crisis is ongoing, they could be transferred to an inpatient facility for more intensive mental healthcare. Certainly there are concerns with this move, as inpatient facilities have historically been difficult to access and have a checkered past. Overall, however, a “third place” could provide the continuity in care, stability, and sense of dignity that emergency rooms and carceral facilities often do not provide.
Such a “third place” is not wholly unprecedented. Arizona’s Crisis System, for example, was created in reaction to a string of tragedies related to mental health. The program established stabilization centers which provide 24/7 intake, professional observation, and access to Medication Assisted Treatment for those struggling with Substance Use Disorder (SUD). The state also set up a crisis telephone line (an alternative to 911) and deployed 24/7 mobile response teams made up of behavioral health professionals. Today, Arizona’s Crisis System is part of the everyday emergency response pipeline and has led to a decrease in visits by individuals in crisis to jail and the emergency room. Even more striking, 85% of individuals remain stable in the weeks to months after their encounter with a mobile response team or visit to a stabilization center. The “third place” model for mental health care can work – it just needs to be adopted broadly.
Our country has a dire need for expanded mental health and substance use services. While effective rollout will be difficult, the framework is quite simple. Third places in communities make them more livable. Third places for crisis care make mental health care more affordable, effective, and humane. Our traditional crisis care system is failing and, as a result, millions of people are not receiving the treatment they deserve. A “third place” is just what we need.
Spencer Andrews (J.D. 2026) hails from small-town Indiana and worked for three years as a research fellow at the National Institutes of Health (NIH) before attending law school. His background in neuroscience inspired him to dig deeper into the societal impacts of addiction and mental illness in the U.S.
