It’s well-recognized by emergency care practitioners that emergency psychiatric patients (EPPS) presenting with psychiatric-related complaints can often wait for hours—and sometimes days—to be seen by a clinician specially trained to provide definitive psychiatric evaluation and treatment. This lack of access not only results in suboptimal evaluation and treatment for this cohort, it also creates unnecessary emergency department crowding and delays care for all patients. In addition, the busy, anxiety-provoking emergency department environment can exacerbate the conditions of this patient population.
Current experience suggests that up to 75 percent of psychiatric patients on an ED hold can be discharged without in-patient admission.1 Having appropriate psychiatric emergency services available not only improves care and decreases ED crowding, it significantly unburdens our already taxed in-patient psychiatric patient services.
The CSU Option
Crisis Stabilization Units (CSUs) provide intensive mental health crisis services to ED patients with psychiatric conditions who would otherwise have lengthy ED stays and/or be unnecessarily hospitalized. CSUs are an effective option for a variety of ED patients with psychiatric complaints, including repetitive users of emergency and inpatient psychiatric services, those with co-occurring substance abuse disorders, those needing emergent psychiatric medication management, and those whose presenting problems could be met with short-term (less than 24 hours) immediate psychiatric care and linkage to community-based resources.
CSUs provide crisis intervention services, including integrated services for co-occurring substance abuse disorders. They focus on recovery and linkage to ongoing community services and support and are designed to impact unnecessary and lengthy involuntary inpatient treatment, promoting care in voluntary recovery-oriented treatment settings.
To respond to patient needs, CEP America is partnering with hospitals and communities throughout the nation to co-create psychiatric emergency services (PES)/CSU models to meet the needs of the population and community. The program is pursuing two options to meet the needs of ED patients with psychiatric emergency conditions:
1. PES/CSU units attached to an acute care facility. This model allows for efficient medical clearance within the emergency department, transporting the patient to the PES/CSU afterward. It supports safe patient care delivery, meeting Emergency Medical Treatment and Labor Act (EMTALA) requirements.
2. Freestanding PES/CSU units. Partnerships with medical emergency departments are established to promote rapid access for patients requiring further medical stabilization.
Both models designate the psychiatric provider as the initial patient contact, providing the emergent psychiatric assessment and treatment initiation. When clinically indicated, medications are ordered in response to a patient’s needs. Upon completion of the assessment, patients enter into the therapeutic milieu, a healing environment staffed by psychiatric professionals.