Last month we explored the first of the three areas of crisis care that Viewpoint Foundation wants to make headway in – diverting patients away from emergency rooms and into community-based care. This month we will look at who needs to be in the ER and how their experience can be better suited to their needs.

Why is mental illness the only emergency where the treatment plan is, Let’s find them a bed somewhere?... If someone comes in with an asthma attack, we don’t say, ‘We’ve got a gurney here in the back for you. We’re going to try to find you an asthma hospital in a day or two, so sit tight.’ For psychiatric patients, this transitional time was therapeutic dead space—a missed opportunity. Could it be transformed into a period of healing? (Khullar, 2023)

Emergency departments play a crucial role in providing immediate care and intervention for individuals facing injurious and mental health crises. Mental health emergencies are complex situations that require prompt and effective responses to ensure the safety and well-being of those affected but are often not straightforward fixes like a physical wound would be. In recent years, there has been a growing recognition of the need for specialized mental health treatments and services within emergency departments to address the unique challenges posed by psychiatric emergencies. This is because a visit to the ER can make a mental health crisis worse with an overwhelming and overstimulating environment from high levels of activity, bright lights, and noise, coupled with wait times that are much longer compared to physical injury patients (4.1 hours longer when discharged and 23.3 hours longer when admitted (Medeiros et al., 2019)). On top of that, is the fact that after being triaged, patients are often either sent home with no supports, or kept in conditions “many patients said felt like jail” (Khuller, 2023).

The question then becomes; how do we make emergency rooms better for those mental health patients who need to be there?

The answer lies in having a separate space that is staffed with people who are trained mental professionals and understand the severity of mental health crises. The true breakthrough in these trauma-informed spaces involves a fundamental change in our approach to healthcare. While we typically attribute the power to make a difference in a medical setting to drugs, devices, and procedures, it's essential to recognize that the physical spaces themselves can also have therapeutic effects. (Khuller, 2023)

An example of this type of model are EmPATH (Emergency Psychiatry Assessment, Treatment, and Healing) units. These units utilize a separate space from traditional ERs that has comfortable furniture, lots of natural light, calming decorations, books, puzzles, and even exercise bikes to help patients focus, and sensory areas where patients can listen to music, change the colour and intensity of the lighting, and recalibrate. (Khuller, 2023)

Following the establishment of the initial EmPATH unit, the occurrence of psychiatric patients staying overnight in local emergency departments dramatically diminished, reaching nearly zero. Furthermore, in conventional emergency departments, up to twenty percent of individuals facing a mental health crisis could find themselves subjected to some form of restraint. In contrast, within the EmPATH unit, this figure was reduced to 0.1 percent, a difference that is attributed to the calm environment and specialized staff. (Khuller, 2023)

Mental health emergency departments need to be able to also provide crisis intervention services for individuals experiencing acute mental health crises. Crisis intervention may involve de-escalation techniques, supportive counseling, and the administration of appropriate medications to stabilize the individual. Skilled mental health professionals collaborate with medical staff to tailor interventions to the unique needs of each patient. (Hilton et al., 2023)

Many emergency departments have established psychiatric consultation services, allowing on-site or remote access to mental health specialists. These consultations provide valuable insights into diagnosis, treatment options, and discharge planning. Psychiatric consultations contribute to a more comprehensive understanding of the individual's mental health needs and guide the development of an appropriate care plan. (Hilton et al., 2023)

In cases where individuals require more intensive care, mental health emergency departments may facilitate inpatient admission to psychiatric units within the hospital. This allows for ongoing monitoring, medication adjustments, and therapeutic interventions in a controlled environment. Inpatient psychiatric care is critical for individuals in acute distress or those at risk of harm to themselves or others. (Hilton et al., 2023)

One of the most important aspects of successful mental health care is the establishment of bridges between ERs and community-based mental health services. Upon stabilization, individuals may be referred to outpatient mental health clinics or respite centres, crisis hotlines, support groups, or other community resources to ensure ongoing care and support. These collaborative efforts help promote long-term mental health and stability through a seamless continuum of care. (Hilton et al., 2023)

Mental health treatments and services within emergency departments are essential components of a comprehensive mental health care system. As awareness of mental health issues continues to grow, the integration of specialized spaces and services in emergency settings becomes increasingly vital. By combining traditional medical expertise with non-traditional aspects of care and mental health interventions, emergency departments contribute significantly to the well-being of individuals in mental health crises, ensuring they receive timely and appropriate care. This collective approach ultimately fosters a more compassionate and effective response to mental health emergencies within the healthcare system.

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