It’s likely you’ll be surprised at the amount of great work community-based organizations are conducting and the resources they can provide. These may help tremendously within the post-discharge world. There is a strong effort among most state and managed care organizations to increase outreach with high-risk individuals through the efforts of community health workers and others, often with a focus on lived experience within hired staff. Alternative options of care are growing rapidly within communities around the country, and it behooves us to connect with and be knowledgeable of the resources they can offer.

What’s Next?

Much work has already been done to address mental health emergencies, but much more remains. Our committee is working on additional articles related to behavorial health concerns, including best practices in risk stratification, the initiation of medication, and more.

American EDs are responsible for managing millions of visits for mental health issues. Working together, EPs can and will continue to improve the care these patients receive, both inside and outside of the ED.

Dr. Enguidanos is the chair of ACEP’s Emergency Medicine Practice Committee (EMPC). He is Founder/CEO of Community Based Coordination Solutions.

Dr. Miller is the Chief Medical Officer of Vituity. Dr. Miller leads an EMPC sub-committee focused on mental health issues in the ED. 

References

1. Moore BJ (IBM Watson Health), Stocks C (AHRQ), (AHRQ). OP. Trends in Emergency Department Visits, 2006-2014. HCUP Statistical Brief #227. Agency for Healthcare Research and Quality; 2017.
2. Theriault KM, Rosenheck RA, Rhee TG. Increasing emergency department visits for mental health conditions in the united states. J Clin Psychiatry. 2020;81(5).
3. ACEP Emergency Medicine Practice Committee. Practical solutions to boarding of psychiatric patients in the emergency department. does your emergency department have a psychiatric boarding problem? American College of Emergency Physicians website. Published 2015. Accessed April 26, 2023.
4. Czeisler M, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the covid-19 pandemic—united states, June 24-30, 2020. Morb Mortal Wkly Rep. 2020;69(32):1049-57.
5. Anderson KN, Radhakrishnan L, Lane RI, et al. Changes and inequities in adult mental health-related emergency department visits during the covid-19 pandemic in the us. JAMA Psychiatry. 2022;79(5):475-85.
6. Holland KM, Jones C, Vivolo-Kantor AM, et al. Trends in US emergency department visits for mental health, overdose, and violence outcomes before and during the covid-19 pandemic. JAMA Psychiatry. 2021;78(4):372-9.
7. Lucero AD, Lee A, Hyun J, et al. Underutilization of the emergency department during the covid-19 pandemic. West J Emerg Med. 2020;21(6):15-23.
8. Sun Y, Wu Y, Fan S, et al. Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts. BMJ. 2023;380:e074224.
9. Mental Health & Substance Abuse Information-Papers. ACEP website. Accessed April 26, 2023.
10. Nazarian DJ, Broder JS, Thiessen MEW, et al. Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Ann Emerg Med. 2017;69(4):480-98.
11. Adult Psychiatric Emergencies. American College of Emergency Physicians website. Accessed April 26, 2023.
12. Pediatric Mental Health Emergencies in the Emergency Department. American College of Emergency Physicians website. Accessed April 26, 2023.
13. Mental Health Advocacy. American College of Emergency Physicians website. Accessed April 26, 2023.
14. Mental Health and Substance Use Disorders. American College of Emergency Physicians website. Accessed April 26, 2023.