Johns Hopkins Psychiatry Guide

Emergency Psychiatry

Matthew E. Peters, M.D., Cynthia Major Lewis, M.D., Pat Triplett, 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
  • 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[2]
  • The most important consideration in emergency psychiatry is the safety of all parties[3]:
    • A systematic approach to assessment, stabilization, and 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[4]:
    • 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

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Last updated: January 29, 2017