Last month, I wrote about community-based mental health care, highlighting the Recovery Café model. We are thrilled to announce that this model has inspired the creation of a new peer-led mental health support space at Mount Royal University (MRU), set to launch this month as students return to campus. Collaborating with the MRU team has been a rewarding experience, and we are energized by the potential scalability of this approach and the transformative impact it could have on post-secondary institutions across Canada.
At Viewpoint, we recognize that community community-based care isn’t always the right fit for individuals in acute mental health crises who require medical interventions in a hospital setting. This month, I want to shift focus to explore how emergency rooms can be redesigned to be trauma-informed in order to better accommodate mental health treatment, ensuring they are safe and supportive spaces for those in crisis.
Trauma-Informed Spaces
Trauma-informed spaces in mental health emergency departments are designed to acknowledge the widespread impact of trauma and create environments that promote safety, healing, and trust. Traditional emergency rooms can often feel chaotic and overwhelming, which can be particularly re-traumatizing for individuals experiencing a mental health crisis. In response, trauma-informed spaces focus on minimizing these stressors through intentional design, staff training, and patient-centered care. This might include quieter, more private areas to reduce sensory overload, softer lighting, comfortable seating, and an overall environment that feels less clinical and more calming. These elements are essential to providing a sense of safety, which is foundational to trauma-informed care. (Merotto & Simpson, 2023)
Beyond the physical space, trauma-informed approaches emphasize the importance of understanding the psychological and emotional needs of patients. Staff in these environments are trained not only to treat the immediate symptoms but also to approach care with empathy and awareness of the potential for past trauma. This fosters a supportive atmosphere where patients feel respected and empowered, helping to de-escalate crisis situations and reduce the likelihood of re-traumatization. In trauma-informed mental health emergency departments, the goal is not only to stabilize patients but to do so in a way that promotes long-term recovery and resilience, recognizing that compassionate care is a critical part of the healing process. (Merotto & Simpson, 2023)
Armed with this knowledge of the benefits of trauma-informed spaces and the general consensus that “[i]t’s hard to imagine a less therapeutic environment for a person in crisis than an emergency department: crowded and windowless rooms; harsh fluorescent lights; the ceaseless ping of alarms…” (Khullar, 2023), a shift is occurring in how emergency departments are designed and operate.
EmPATH Units
EmPATH (Emergency Psychiatric Assessment, Treatment, and Healing) units were invented by Scott Zeller in 2012 out of his frustration at the current state of care for mental health patients in emergency rooms. These units address the unique needs of patients in psychiatric crisis through an emphasis on creating a quiet, calming, and supportive environment. These can be shared or private rooms that have sensory modulation (lighting, colors, and sounds, as well as exercise apparatuses and natural lighting that promote calmness), patient autonomy in retrieving comfort items such as warm blankets and snacks is encouraged, staff are trained in de-escalation techniques, and patients can receive a comprehensive evaluation, start therapy, and, if needed, receive medication. (Khullar, 2023)
After this space was implemented at Zeller’s hospital:
"[t]he number of psychiatric patients who stayed overnight in the area’s emergency departments fell almost to zero. In a traditional emergency department, as many as twenty per cent of patients experiencing a mental-health crisis might end up being restrained in some way; in Zeller’s unit, the number was 0.1 per cent, a difference that he attributes to the calmer environment and specialized staff. The average wait time in the emergency department for people with acute mental-health conditions dropped from more than ten hours to less than two, and, because patients received immediate attention once they got to Zeller’s unit, three-quarters were able to go home, where they tend to have better long-term outcomes, instead of being hospitalized." (Khullar, 2023)
This model is not without its challenges. Having the actual physical space to house an emergency room focused on mental health patients is the first hurdle to cross, but then you need to have adequate staffing and training. Finding and retaining staff with this expertise can be difficult, particularly in areas facing broader healthcare workforce shortages. Balancing these needs with budget constraints can be a significant operational challenge.
Another challenge is the seamless integration of EmPATH units with broader healthcare systems, community-based services, and local law enforcement. When patients require hospital admission, need to transition to community care, or police are involved in escalating crises, coordination across these sectors becomes critical. A breakdown in communication or processes can result in significant bottlenecks, leaving patients waiting too long for the appropriate level of care.
Trauma-Informed Emergency Rooms in Calgary
It is exciting to hear about this type of shift happening generally, but it is even more exciting when it is happening in your hometown. While most hospitals in Calgary are making plans for a designated mental health emergency space, those at the Peter Lougheed Centre have been expanded significantly. The hospital’s emergency room is one of the busiest in Alberta, seeing over 82,000 visits annually, with mental health-related visits having increased by more than 30% over recent years. To address this, the Peter Lougheed Centre received substantial provincial investment to upgrade its emergency department and build a mental health intensive care unit, as well as expand its short-stay mental health unit. (Pearson, 2020) Utilizing similar trauma-informed policies and design elements that were discussed above in EmPATH units, these spaces have transformed both the patients' experience with receiving treatment and caregivers' experience in their work environment.
The Peter Lougheed Centre also provides a psychiatric emergency services, aimed at crisis intervention and psychiatric assessment for patients referred by traditional emergency room physicians. These services include mental health assessments, crisis stabilization, safety planning, and referrals for further community-based support after discharge. The goal is to offer a continuum of care that begins in the hospital and extends into community support, ensuring patients don’t fall through the cracks once they leave the acute care environment (Calgary Health Foundation, 2022).
Trauma-informed emergency rooms play a crucial role in providing compassionate and effective care for mental health patients. By prioritizing safety, empathy, and collaboration, these facilities can better address the unique needs of patients while fostering a healing environment. Moreover, integrating these emergency services with community-based programs enhances the continuum of care, ensuring that individuals receive the ongoing support they need beyond the emergency room. This holistic approach not only benefits patients but also strengthens the overall health care system, promoting resilience and recovery within the community.
Bibliography
Calgary Health Foundation. (2022). Mental health. In 2022 impact report. https://www.calgaryhealthfoundation.ca/2022-impact-report/mental-health/
Khullar, D. (2023). Reinventing the E.R. for America’s mental-health crisis. The New Yorker. https://www.newyorker.com/science/annals-of-medicine/reinventing-the-er-for-americas-mental-health-crisis
Merotto, B., & Simpson, S. A. (2023). Trauma-Informed Care, Psychological First Aid, and Recovery-Oriented Approaches in the Emergency Room. Emergency Psychiatry, 440.
Pearson, H., Global News. (2020). Emergency room expansion, mental health ICU coming to Calgary’s PLC hospital. https://globalnews.ca/news/6570328/calgary-peter-lougheed-centre-hospital-expansion/