Hospital emergency departments (EDs) have become the front lines of mental health crises. However, the increasing volume and severity of behavioral health cases, coupled with limited resources and a lack of community-based behavioral health treatment options, means that we lack the capacity to provide an effective level of care. It happens often.
Overloaded EDs increase wait times, increase the likelihood of medical errors, increase costs, increase stress for healthcare providers, and generally lead to poor patient health outcomes.
To alleviate pressure on the healthcare system, healthcare providers across the continuum of care must collaborate on patient-centered, nuanced, holistic behavioral health solutions that go beyond traditional ED care.
Current state of behavioral health care in the ED
One in three Americans has a substance use disorder or mental illness, and 17.3 million U.S. adults experience major depressive disorder. Children’s hospitals saw a 20% increase in ED visits for mental health cases and a 50% increase in ED cases for suicide and self-harm from 2019 to 2022.
When adults and children with mental health problems turn to emergency care instead of community resources, the health care system becomes overwhelmed. More than 50% of acute care hospitals and hospitals do not have psychiatric services. Additionally, EDs are not designed to provide a safe treatment environment for people with acute mental health problems, especially those experiencing suicidal ideation, severe depression, or psychosis. yeah.
High stress environments can worsen mental health. Poorly equipped emergency medical staff may rely on sedation, which may delay appropriate psychiatric evaluation. Or you could err on the side of caution and admit a patient, preventing bed rotation. This can impact outcomes and readmission rates. One in five of her emergency department mental health patients relapses within her six months.
Fortunately, the health system has new approaches to care that allow health professionals the flexibility to scale as demand for behavioral health ebbs and flows.
Future Directions: Using new care approaches to reduce ED burden
Emergency physicians in need of a pressure valve can now turn to a new option along the treatment continuum. Some exist within the health care system, while others bypass the ED entirely and provide specialized care to behavioral patients in alternative care settings.
- Telepsychiatry services: Mental health professionals are in such high demand that hospitals may not be able to hire and retain professional staff quickly. Psychiatrists in particular tend to be expensive and difficult to hire. Another approach is to employ telepsychiatry services that provide access to psychiatric consultation and care when needed. Telepsychiatry has been adopted by approximately 20% of U.S. hospitals and has been approved by the American Psychiatric Association as an effective means of providing psychiatric care. Certain telepsychiatry solutions can provide care coordination services that help manage and expedite patient flow from the emergency department to the most clinically appropriate treatment site.
- Emergency Psychiatric Assessment, Treatment, and Healing Unit (EmPATH): EmPATH units are located in or near the ED within a hospital. Behavioral patients are transferred after their medical needs have stabilized. These units provide a calming and supportive environment that is more suitable for behavioral patients. Healthcare providers can observe patients for up to 24 hours, reducing ED boarding times and unnecessary hospitalizations, freeing up ED staff to support other patients with urgent medical needs . The EmPATH unit also prioritizes follow-up care to reduce readmissions. One study found a 60% increase in 30-day follow-up care established at discharge.
- Crisis Stabilization Unit (CSU): As an alternative to the ED for acute care, specialized facilities or small specialized teams, such as CSUs, are dedicated to behavioral health treatment. These can provide care to specific populations, such as children and teens. It also serves as a turning point from incarceration for behavioral issues. Whether in-person or virtually, CSU providers can discreetly alleviate acute mental health issues, conduct psychological evaluations, and initiate stabilizing treatment. These separate teams or facilities (also known as crisis reception centers) are often the first stop for patients after being dropped off by emergency medical services or police, or from an emergency hospital if a patient’s condition worsens. as a transfer point, with two-way routes from the emergency hospital. Suitable for CSU.
- Intensive Outpatient Program (IOP): The goal is always to treat patients at the most clinically appropriate and least restrictive level of care. Hospital stays can be traumatic, disruptive, and costly for patients and their families, especially when patients can be safely treated or discharged to a lower level of care. IOP is valuable after acute hospital discharge for patients with moderate to severe mental health conditions and can help reduce readmissions. Treatment takes place over several hours each week and is increasingly available via telehealth platforms to streamline access. Hospitals have an opportunity to further invest in outpatient behavioral health resources, such as step-down IOP programs, to improve patient outcomes and reduce ED burden. In addition, these programs also help preserve inpatient psychiatric resources for patients who truly need that level of care.
Through these new approaches, telehealth services can help bridge the gap and ensure access to highly qualified clinicians while also strengthening emergency medical staff and resources. In some cases, telemedicine clinicians can better track and maintain a patient’s treatment path from inpatient to outpatient, building trusting relationships and providing consistency. You can contribute to outcomes.
Another bridging option between intensive inpatient and outpatient treatment is partial hospitalization. Patients can attend counseling and therapy sessions during the day and return home to their families and communities in the evening.
By optimizing care journeys based on patient needs and leveraging collaborative resources outside the ED, we can deliver effective and efficient behavioral care, regardless of volume.
Successful resolution of the ED mental health crisis requires rapid tailoring of treatment based on patient risk through accurate and comprehensive psychiatric assessment and treatment stabilization. By combining telemedicine with innovative mental health facilities, we can cover the range of mental health issues and optimal treatment pathways, ultimately building stronger connections across the continuum of care, Better patient outcomes can be achieved.
Photo: Professor25, Getty Images
Mark Alter, MD, is Executive Vice President and Chief Medical Officer of Emergency Medicine at Array Behavioral Care, where he manages a team of on-demand care clinicians by guiding telemedicine and industry best practices. Dr. Alter is board certified in pediatrics, psychiatry, and child and adolescent psychiatry, and is a principal investigator in the Department of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania. Dr. Alter’s more than 14 years of clinical experience in behavioral health and his affiliations with more than 10 medical facilities provide Array’s partners with extensive clinical and operational expertise.