Providing Crisis Respite Care: Q&A with Graydon Andrus, Director of Clinical Programs at Downtown Emergency Service Center in Seattle, Washington

Downtown Emergency Service Center's Crisis Respite Program helps homeless adults who are experiencing a behavioral health crisis and are being discharged from emergency rooms or other crisis services. It helps to meet their immediate needs and stabilize their life by providing shelter and connection with critical resources such public entitlements, housing, and on-going treatment. To learn more, the HRC’s Ken Kraybill talks with Graydon Andrus, Director of Clinical Programs at Downtown Emergency Service Center in Seattle, Washington.

Q: Why is crisis respite important for people with severe mental illness?

Without this program, many people would be left with little choice but to return to the streets. This increases their chances of cycling through costly public services such as emergency rooms, jails and courts, and remaining homeless.

Q: How did DESC’s Crisis Respite Program (CRP) come about?

In 1998, county officials approached DESC about creating a discharge option for people exiting the behavioral health arm of the emergency room at the county hospital. They recognized that offering psychiatric appointments the next day was not an effective service strategy for people facing homelessness.

Q: What makes CRP work well?

We are very welcoming and very assertive. Our goal is to help people get back on their feet and to access the resources they need. CRP has twenty beds, and the average stay is a couple of weeks. The program operates 7 days a week, twenty-four hours a day. We have 2-3 case managers per shift. They work collaboratively with individuals to develop goals and service plans. CRP has limited access to a psychiatric nurse practitioner to deal with medication issues. Linkages to other DESC programs, such as outpatient mental health, shelter, and substance abuse treatment are also central to our success.

Q: What are some lessons you have learned over the past 11 years?

• A little customized effort can go a long way. It is possible to achieve a lot in a relatively short period of time.

• It is essential to maintain strong relationships with programs we refer to and those that refer to us.

• Operating within a larger shelter’s infrastructure allows us to be cost effective.

• It often takes multiple attempts for clients to succeed.

• It continues to be very hard to provide continuity of care for non-Medicaid and undocumented folks.

Q: What are the top reasons to develop a crisis respite program?

• It plays a key role in re-engaging clients with mental health services from which they had become disconnected.

• It builds a bridge to mainstream services for people who may have trouble with the typical process or who have impulse control issues.

• It helps people in crisis to regroup and reconnect in a welcoming, caring environment.

• It saves public money through decreased use of emergency rooms, and fewer hospital and jail admissions.

Q: If people want to create a crisis respite program, where can they go?

There is not much literature on this. Interested persons are welcome to contact me for consultation. My contact information is: Graydon Andrus, MSW, Clinical Director, DESC Clinical Programs, email:

Publication Date: 
Newton Centre, MA, USA