Getting help for a psychiatric crisis at a hospital emergency room is not wrong, but there are alternatives that may be safer and less overwhelming.

A security guard in a Valley hospital emergency room was shot and injured, reportedly by a patient who was experiencing hallucinations and hearing voices. The patient's relative took him to the hospital because of his behavior, Scottsdale police have said.

Not all details about the March 2 incident, including the patient's mental health history, have been publicly disclosed and it's unclear whether the outcome could have been prevented, particularly because the patient had a gun.

But the shooting can serve as a reminder that there are options other than a hospital ER for getting help, specifically by calling 988 or by going to a 24/7 psychiatric crisis center, mental health advocates say.

Alternatives to the ER for someone in a mental health crisis

ERs can be busy, noisy and wait times may be long. Such an environment could be frightening to someone who is experiencing paranoia or other severe psychiatric symptoms, said Rachel Streiff, co-founder of an Arizona group called Mad Moms, which comprises friends, relatives and parents of people with serious mental illness.

"You are less likely to get arrested if a crisis-trained officer is handling your situation," she said. "By calling 988 you are more likely to get a crisis intervention trained officer who knows more about these situations."

Psychiatric crisis centers, sometimes known as psychiatric emergency rooms, are equipped to handle the combativeness of someone in a mental health crisis, Streiff said. But there's not enough awareness or education about where they are and what they do, Streiff said.

Arizona's network of crisis psychiatric care centers are open 24/7, 365 days a year and have nationally-recognized "no wrong door" policy, meaning it's never wrong for anyone 18 and older to go there with behavioral health problems. Insurance status doesn't matter, nor does the reason for seeking help. It could be substance misuse, alcohol withdrawal, a first psychotic break, or anxiety. Behavior issues also could be rooted in a physical medical problem, like reaction to a medication or a brain tumor.

"We specialize in behavioral health, so it's really like going to a specialist. … Crises are very individualized. A crisis for me is very different from a crisis for you. It doesn't matter what it looks like. Come on in and we'll get you triaged and figure out what's going on," said Jamie Pothast, chief officer of crisis services for Community Bridges Inc. , which has several crisis centers in Arizona.

"Unfortunately people don't find out about this service until they need it themselves or are with someone who needs it and it's very overwhelming."

Driving someone who's in a psychiatric crisis is risky, attorney says

Driving someone who is experiencing a psychiatric crisis to a hospital emergency department or to a crisis center may not be the safest choice, said Phoenix attorney Holly Gieszl, an expert in handling mental health cases. The person in crisis could jump out of the car, or try to grab the steering wheel, she said.

"Many bad things can happen if a loved one is trying to transport a friend or a family member in a psychiatric crisis to the emergency department. It's always risky," Gieszl said. "Transporting someone to an emergency room with a broken hand or appendicitis is not the same as transporting someone in a psychiatric crisis. … But I think it's understandable that family members try to do it."

Emergency departments at major hospital systems in the Phoenix area are very well-equipped to handle people in mental health crises, Gieszl said. But if she had loved one experiencing psychosis, her instinct would probably be to call either 988 or 911, she said.

Not enough people know about 988, Streiff said. The 988 Suicide and Crisis Lifeline replaced the National Suicide Prevention Lifeline (800-273-TALK) in 2023. The 988 crisis line, an alternative to 911, is becoming a national catalyst for reducing law enforcement's often intimidating and sometimes deadly responses to people who are having a mental health crisis.

Too many people believe 988 is only for people experiencing suicidal thoughts, but that is not true. Rather, 988 is for a range of mental health issues. Streiff said 988 can connect callers with a mobile crisis team and with a psychiatric crisis center.

"We've got to start promoting the 988 crisis hotline for these types of situations," Streiff said. "There is not enough awareness and education about using the crisis line for acute agitation like psychosis. … How would the average person on the street know any of this?"

24/7 psychiatric crisis centers specialize in behavioral health

Four of the psychiatric crisis centers in Maricopa County have the capacity to handle involuntary psychiatric commitments, in addition to people who are there voluntarily. But if someone goes to a voluntary center and it turns out they need that involuntary service, Community Bridges will work with the closest involuntary provider to get them over there safely, Pothast said.

Involuntary psychiatric commitment has a high bar and includes several steps, including a judge's order. Someone who is court-ordered to get mental health treatment must be found to be a danger to themselves or others or gravely disabled by their mental illness, according to Arizona law.

"Everyone is going to see a variety of staff for behavioral health assessments to kind of gauge where they are at safety-wise, to ensure they are able to keep themselves safe and be safe in the community," Pothast said.

"It's really come in as you are. No appointment necessary. All of the crisis receiving centers have medical staff 24/7, so a variety of registered nurses, nurse practitioners (family and psychiatric), psychiatrists, and we do a variety of urine screens, drug monitoring tools, blood work, things like that, to figure out what is going on."

Community Bridges often gives patients a "bridge" prescription, meaning they get a short-term prescription for psychiatric medication until they are able to see an outpatient psychiatrist or provider on a regular basis, Pothast said. The backbone of its program is connecting people with peer supports who have gone through similar experiences, she said, which is different than the treatment a patient would receive in an emergency room.

"Typically when a behavioral health patient shows up to an emergency room, they are going to be looking to transfer that patient out to a behavioral health provider," Pothast said.

People in psychiatric crises get locked up for being ill, advocate says

The patient accused of shooting a security guard at about 1 p.m. March 2 at HonorHealth Scottsdale Shea Medical Center was identified as 30-year-old Maximillian B.D. Yanofsky, who was described as mentally disturbed and a "danger to the public" when he was taken into custody, according to the court documents.

Streiff said too often there's a secondary tragedy when mental health crises become violent and there isn't a trained crisis intervention officer to help de-escalate the situation. People who are ill and in need of medical attention due to a brain condition that's not their fault are getting arrested, jailed and then they aren't getting the care they need, Streiff said.

"At least these psychiatric emergency rooms that we have, that few people know about in the mainstream public, they are at least equipped to handle agitation and combativeness associated with a psychiatric event," she said. "These are really specialty circumstances for acute psychiatric hospitals to deal with."

Arizona's Medicaid program maintains a Google Maps list of walk-in mental health crisis observation and stabilization facilities that can be viewed at https://tinyurl.com/2cjwdrwr .

Republic reporter Hannah Dreyfus contributed to this article .

Reach health care reporter Stephanie Innes at [email protected] or follow her on X, formerly Twitter: @stephanieinnes.