For over a decade, we have been experiencing an ever-growing mental health crisis. Currently, 1 in 5 US residents live with a mental health disorder and less than half of these individuals receive adequate mental health care. This trend has taxed a limited number of behavioral health services/resources and has resulted in individuals not receiving timely or appropriate care. This trend has also led numerous psychiatric professional organizations and hospital associations across the country to declare a national mental health emergency.
One important characteristic of this crisis is the overutilization of Emergency Departments (EDs) to serve as both an emergency resource as well as the front door to all behavioral health services. As such over the last 7 years, there has been a five-fold increase in the number of patients admitted to emergency departments for mental health disorders. In California alone, there are an average of 2,143,614 mental health ED visits annually, and anywhere from 13-15% of all ED visits nationwide are mental health admissions in nature. The growing need for emergency psychiatric care has resulted in multiple struggles for hospitals and patients. These include extending the patient's length of time of care, the ED's inability to meet the mental health needs of the patient, ED environments increasing the patient's level of stress leading to a higher need for restraints, patients feeling like a burden to the hospital, and health inequities. Furthermore, EDs are increasingly meeting this challenge with a practice known as boarding, which the Joint Commission (accrediting body for hospitals) suggests leads to lower quality care and ultimately worsens ED crowding.
In parallel, communities have been attempting to remedy this challenge with a host of new crisis resources including mobile crisis units, mental health hotlines (e.g., 988) and crisis stabilization units. Given that these interventions are mostly upstream oriented, they may not likely to immediately resolve the stress on emergency services. Rather, an alternative strategy is being employed by a growing number of health systems. More and more hospitals are setting up psychiatric crisis emergency departments or similarly, psychiatric observation units. These practices may be helpful, but a specific model, known as EmPATH (Emergency Psychiatric Assessment Treatment and Healing), has a demonstrated positive outcome for patients and health systems.
Here at Loma Linda University Health we have partnered with the California Department of Mental Health Service Oversight and Accountability Commission and EmPATH model developers to launch a new approach for emergency mental health crises.
With funding received from the California Department of Mental Health Service Oversight and Accountability Commission, the LLUH behavioral health team is in the process of converting the former Emergency Department space into adult and youth EmPATH units. The cutting-edge approach used in EmPATH units allows a specially trained multidisciplinary team to treat mental health crises in an environment specifically tailored to the unique needs of patients. Rather than the fast-paced and stressful environment of typical emergency departments, these units focus on open spaces with an emphasis on calming lighting, colors, and interventions. The overall goal is to reduce the immediate crisis but also to support the access to and utilization of next stages of care for the patient and their families.
Current empirical studies suggest that these units have significantly reduced the average length of stays in emergency departments, reduced the need for boarding, increased access to follow-up care, reduced recidivism, and reduced the pressure on scarce behavioral health inpatient beds. Newer studies are providing growing evidence that these units also improve costs associated with psychiatric emergency care.
Written by Dr. Brian Distelberg, Professor, Counseling and Family Sciences