Go to a hospital emergency department with symptoms of a physical emergency such as chest pain or a broken leg and you’ll be met by a team of doctors and nurses who know exactly what to do. They will assess you quickly and competently using established protocols. Most of them will be compassionate and kind, making you feel safe and cared for.
It’s a different experience if you walk into the same emergency department having an acute behavioral health crisis. Maybe you’re hearing voices or have attempted suicide. You’re upset and scared — probably agitated, irrational, and disoriented. You may have to wait hours in a crowded, noisy waiting room or worse — in a locked examination room, possibly restrained or monitored by a guard. You could be left on a gurney for hours, or even days, until the default treatment, a bed in an inpatient psychiatric unit, becomes available.
Here’s the bottom line: Psychiatric patients in the emergency department can end up being treated as less than human. All too often, I’ve seen the standard approach to care escalate what is already a tenuous, scary, and traumatic situation for everyone.
And we’re up against some frightening numbers. Emergency visits for suicidal thoughts and suicide attempts have increased by more than 40% since 2006, while behavioral health visits to emergency departments have increased by nearly 57% for children and 41% for adults. And every emergency department across the country has witnessed an explosion of opioid overdoses — another tragic manifestation of untreated mental illness.
In my 20 years as a hospital-employed physician working hand in hand with my emergency medicine colleagues, I know firsthand that addressing this need begins with changing the way we relate to these patients. This begins with listening and approaching patients as the human beings they are.
The most effective tools we can use are ones we already possess: empathy, kindness, and a mindset of treating people the way we would want to be treated. This is the essence of the EmPath model (short for emergency psychiatric assessment, treatment, and healing unit), which creates a safe space designed to calm and stabilize patients in behavioral health crises.
Here’s how physicians affiliated with Vituity, the company I work for, use the EmPath model in emergency departments across the country:
A calm environment. Instead of making a patient in crisis wait in the noise and chaos of an emergency department, offer a quiet, darkened space with comfortable chairs to help patients relax.
De-escalation. Patients may come in frightened, angry, or out of control on drugs. While some of them cannot be calmed down by simple dialogue, a surprising number can. Speaking slowly and quietly and assuring them, “We’re going to get through this together,” goes far in reducing aggression and building trust that the clinicians are there to help.
Immediate access to a psychiatrist. In the EmPath model, every behavioral health patient is seen right away by an emergency psychiatrist. If one isn’t available on site, patients are given access to one via video. These telemedicine consults work. In fact, many patients find it easier to open up, be vulnerable, and talk honestly when the person they’re talking to is on a screen.
This approach delivers substantial benefits. First, the focus on immediate care means patients get treated and discharged instead of being admitted. Emergency rooms employing the EmPath model have seen a 75% drop in hospitalizations. This helps to avoid boarding, the practice of leaving patients on gurneys while staff members try to find patients inpatient beds. Eighty% of patients seen at an EmPath unit go home within 16 hours.
Like most changes in care delivery, more humane treatment of behavioral health patients in emergency departments won’t be fixed from the top down. Physicians and administrators need to listen to the people on the front lines: nurses, most importantly, but also paramedics and social workers.
Modernizing outdated processes and procedures empowers providers to deliver quality care for all patients, improving outcomes and creating a better experience for patients while reinvigorating health care providers’ passion for their work. Most importantly, patients experience care on a human level which gives communities the confidence and comfort of knowing their local emergency departments can be trusted to handle any health care crisis.
Denise Brown, M.D., is chief strategy officer for Vituity, a physician led and owned multispecialty partnership that delivers acute care to patients in 14 states.