Emergency Psychiatry

DEFINITION

• Emergency departments (EDs) are increasingly utilized by patients in need of psychiatric assessment and care. This trend is due in part to[1]:
  • Shortages of psychiatrists and other mental health professionals
  • Limited and often fragmented systems of outpatient psychiatric care
  • Lack of other sources of support for persons with chronic mental illnesses
  • Steadily diminishing inpatient psychiatric beds, both acute and long-term
  • Increase in patients seeking help for their own mental healthcare[2]
• This combination of increased utilization of ED services with decreased safe disposition options has resulted in skyrocketing rates of ED "boarding" of psychiatrically ill patients[3]
• The most important consideration in emergency psychiatry is the safety of all parties[4]:
  • A systematic approach to a risk assessment, stabilization, and safe disposition is the most effective means to create a safe and effective treatment environment for acute psychiatric conditions.
• The American Psychiatric Association’s Task Force on Psychiatric Emergency Services assembled in 2002 and defined a psychiatric emergency as[5]:
  • An acute disturbance of thought, mood, behavior or relationships that requires an immediate intervention as defined by the patient, family or the community
  • Might also be defined as a set of circumstances in which:
    • The behavior or condition of an individual is perceived by someone, often not the identified individual, as having the potential to rapidly eventuate in a catastrophic outcome AND
    • The resources available to understand and deal with the situation are not available at the time and place of the occurrence.
  • Central to the concept of an emergency include the following, all of which contribute to the need for immediate access to a higher level of care:
    • A lack of prior assessment or adequate planning, with resultant uncertainty
    • Unscheduled, severe, or urgent symptoms
    • Failure of natural or professional supports
• It is also important to be aware of mental health crises, in which someone may not yet require an acute level of care, but may quickly deteriorate and need an emergency evaluation.[6]
  • A person’s thoughts, emotions, and behaviors may put them at increased risk of harming themselves or others.
  • A crisis may put one at risk of not being able to care for themselves or access food, clothing, and shelter.
  • Can occur anywhere, at any time