Emergency Psychiatry

Emma Mangano, DNP, Matthew E. Peters, M.D.
Emergency Psychiatry is a topic covered in the Johns Hopkins Psychiatry Guide.

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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

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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

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Last updated: July 4, 2022