When an individual finally finds the courage to ask for help, what happens next—and how quickly it happens—can permanently shape whether they ever reach out again. Clinical guidelines and research demonstrate that these first 72 hours following a crisis represent the most crucial window for follow-up care. Yet, a stark gap remains between clinical standards and reality: in practice, less than half of Americans receive follow-up support within the first week of a mental health crisis.
Today, the biggest obstacle to effective mental health care is no longer awareness—it is navigation. People do not need more reminders that mental health matters; they need a clear, fast, and responsive route to support when they need it most.
To explore how our healthcare systems can bridge this gap, BlackDoctor sat down with Dr. Vandelyn Sewell, a board-certified psychiatrist and Behavioral Health Medical Director at Elevance Health. Based in Atlanta, Georgia, Dr. Sewell brings over 20 years of clinical experience treating children, adolescents, and adults across diverse settings, with specialized expertise in severe mental illness, trauma-related conditions, and Autism Spectrum Disorder. In addition to her leadership role at Elevance Health, she serves as a clinical assistant professor in the Department of Psychiatry at Morehouse School of Medicine.
Below, Dr. Sewell shares her firsthand insights on interrupting the crisis spiral, dismantling systemic barriers, and how leaders are working to turn “care navigation” from a major obstacle into a unified lifeline.
It is absolutely critical to reach out within those first 72 hours. When you notice that your mental health has taken a turn, success depends on timely outreach, navigating the system, and following up—and following through—within those first three days.
That 72-hour window is enough time for severe symptoms like insomnia, increased drinking, or withdrawing from family and friends to fully kick in. The primary goal of intervening during this period is to interrupt the downward spiral early so that you can fundamentally change the trajectory of the crisis. That is why this specific timeframe is so crucial.
Delaying care can have serious consequences. Sometimes, it helps to relate mental health to physical health because it is more relatable for people. If a person experiences chest pain and notices it starting to escalate, they are not going to wait until they are having a full-blown heart attack to act. They are going to get it checked out immediately—knowing it is far better to find out it is just acid reflux than to realize too late that they are having a heart attack.
It is the exact same with your mental health; we need to conceptualize mental health as healthcare. Failing to get timely help means continued escalation of the crisis. It also means individuals will continue to rely on coping skills that may not serve them well, whether that involves using substances to numb their feelings or engaging in risky behaviors to distract themselves from their pain. Ultimately, you see a sharp decline in daily functioning, both at work and in personal relationships. The longer you wait to get help, the more serious the decline and the worse the final outcomes can be.
When we talk about barriers to care, we see them stemming from many different directions. It often starts simply with stigma, which makes people incredibly hesitant to reach out in the first place. I am heartened by conversations like ours because they allow us to reframe mental health as healthcare, which directly decreases that stigma and helps people feel more comfortable asking for help.
Other major barriers stem from the reality that our mental health system is highly fragmented. It can be incredibly difficult for a person to navigate care from one provider to another, or from one system to another. Because of this, our goal must be to establish a “no wrong door” approach. However, a person manages to get connected to the system, the priority must be about making that initial connection, rather than worrying about having a perfect, flawless plan sorted out in those first 72 hours.
There are meaningful efforts currently being made across various systems—including providers and insurers—to foster better integration. For providers, this means coming together as collaborative groups or, at a minimum, establishing reciprocal relationships so they can facilitate warm handoffs of patients between different care settings.
For insurers, like us at Elevance Health, it means investing heavily in dedicated case management programs. The core idea behind case management is to simplify navigation and connect the dots for the individual. We utilize trained professionals who engage directly with our members to help them navigate complex systems, whether that means providing resources, contacting providers on their behalf, or even directing them to support for social determinants of health, such as food insecurity.
Additionally, we invest in peer support programs. These programs allow individuals with lived experience to walk right alongside folks as they navigate their unique mental health journeys, providing unique insight and personal support.
When it comes to navigating a crisis, a very accessible and helpful system is the 988 Lifeline. A lot of people mistake 988 as strictly a suicide hotline. While it certainly functions as one, there is so much more to it than that.
The lifeline is equipped to manage everything from an acute, severe crisis to someone who simply needs an empathetic person to talk to, and it is available 24/7 through a call, text, or online chat. The core idea is that you are instantly connected to a live person who can help you de-escalate and problem-solve in that exact moment. They will assess your specific level of need and directly help you map out the appropriate next steps based on your situation.
My advice returns to the core rule of the 72-hour window: it is entirely about making a connection, not about finding a perfect solution or figuring out the “just right” thing immediately. Whether you reach out to 911 or 988, the goal is simply to start.
Depending on where you live, some states have dedicated mobile crisis units. You can call these units, and they will dispatch professionals to your location to help, or they can work to help you de-escalate right over the phone. Furthermore, I am seeing more behavioral health urgent care clinics come online. These operate on a model very similar to medical urgent care clinics, and their primary purpose is to bridge the immediate gap in access to care. Wherever you can manage to get a foot in the door is the right place to start.
Support from family and friends is absolutely critical during a crisis. It starts with actively checking in on your loved one. You can approach them gently by saying, “Hey, I noticed something is a bit different lately. How have you been sleeping? How are you eating?” Asking these types of direct, supportive questions when you notice a change is vital.
From there, simply offer to be present. You can sit with them while they make phone calls to schedule an appointment, or you can help take care of practical, day-to-day needs like arranging transportation or assisting with childcare. The ultimate goal is to nudge them toward help, not to shame them or try to talk them out of how they are feeling. If a family does not know where to start, they should remember that lifelines like 988 or mobile crisis lines are also available to support families as they figure out how to help their loved ones.
Technology is playing a massive role in helping people get support within that vital 72-hour window. I am noticing an increase in online platforms that offer same-day or next-day appointments. This has been incredibly valuable, not only because it offers the flexibility of a remote telehealth session regardless of where you are located, but because it allows patients to see someone very quickly, which is extremely important in a crisis.
Another way we are leveraging technology, specifically here at Elevance Health, is through dedicated care navigation apps that we launch for our members. These apps allow members to engage in real-time chat to communicate exactly what is happening in the moment and be immediately directed to the appropriate level of care.
I want people to know that you do not have to be at your absolute worst to deserve care. If you notice a negative shift in your sleep, your daily functioning, or your overall mood, please reach out. Try to reach out within that initial 72-hour window. Whatever door you choose to walk through, remember that there is no wrong door. It is all about prioritizing that critical window for safety, stabilization, support, and eventually, your ongoing follow-up care.
I want to re-emphasize the impact of stigma, because it remains a significant barrier for so many people. It requires a mindset shift: understanding that getting help early is not giving up control of your life—it is actually how you maintain it.
Driving home the point one more time: the earlier you are able to intervene, using that 72-hour window as your guide, the better the final outcomes will be. Early intervention effectively interrupts the mental health deterioration that could otherwise lead to much worse outcomes down the road.
Absolutely. I know firsthand that within the African American community, there is quite a bit of stigma around mental health. We are not a monolith, so this isn’t true pervasively across the board, but the stigma is there.
This hesitation often stems from a few cultural factors, such as a deeply ingrained feeling that you have to handle everything on your own or take care of it entirely by yourself. For some, they worry that seeking psychiatric treatment conflicts with their religious faith—though the reality is that no mental health treatment requires you to abandon your faith. In fact, faith can be an incredibly powerful asset in your recovery journey.
There can also be an underlying narrative of, “We just don’t have those kinds of problems,” but that simply isn’t true. Experiencing a mental health issue doesn’t make us weak; it makes us human. We all have a brain, and our brains can be heavily impacted by internal biology or external stressors. Every single one of us can experience vulnerable moments.
The primary takeaway is the absolute necessity of timely outreach and ongoing follow-through, and keeping 72 hours in mind is a memorable way to guide that timeline. Navigate the system knowing there is no wrong door, but remember to follow through.
True psychiatric treatment does not end with an initial screening or your very first contact with a provider. It is about what we do after we have established basic safety, support, and stabilization. The real healing happens in the ongoing, continuous care.
This interview has been edited for length and clarity.
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