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Empath Units: A New Approach to Psychiatric Emergency Care

ERs are poorly equipped to serve patients with complex psychiatric emergencies

Key points

  • The average duration of psychiatric boarding more than doubled to 4.6 days during the pandemic's first year.
  • Almost a third of ER beds are occupied by individuals experiencing behavioral health emergencies.
  • The system fails to treat complex mental health conditions due to limited resources.

Hospital emergency rooms are poorly equipped to serve patients with complex psychiatric emergencies. Unfortunately, with access to mental health treatment in short supply, this is often where patients end up during a psychiatric crisis. Brought in by well-meaning loved ones or police officers, they will often spend hours or even days on a gurney in the emergency room's noisy, stressful, and chaotic environment while waiting for limited spots in a psych ward. Not only does this fail to treat their conditions due to limited resources, but it also ties up scarce emergency room beds.

The emergence of the COVID-19 pandemic has exacerbated this problem, straining hospital capacities and worsening mental distress among Americans. Research from a pediatric facility revealed that the average duration of psychiatric boarding more than doubled to 4.6 days during the pandemic's first year. A survey by the Massachusetts College of Emergency Physicians showed that almost 30 percent of ER beds in an average hospital were occupied by individuals experiencing behavioral health emergencies, with some remaining there for weeks.

Thankfully, a new and effective approach, the empath unit, has emerged across the nation in recent years, boasting state-of-the-art facilities in various states. The model, now known as the EmPATH unit, was conceived by Scott Zeller, M.D., while serving as the medical director of a psychiatric emergency center in Alameda County, California. Zeller was frustrated that emergency psychiatric conditions were the only cases presenting to emergency rooms for which the default treatment is: Admit to inpatient. It has been demonstrated that the great majority of psychiatric emergencies, like other medical emergencies, can be resolved in less than 24 hours with prompt, appropriate intervention, leading Zeller to develop a new model for treating mental health crises in emergency settings.

The term EmPATH unit stands for "Emergency Psychiatric Assessment, Treatment and Healing unit," reflecting its empathetic rather than coercive care approach. These hospital-based outpatient programs rapidly admit all medically appropriate patients in psychiatric crisis, including those under involuntary psychiatric detention. Unlike being an alternative to inpatient care, the EmPATH unit serves as the destination for acute mental health patients from the ER. Here, decisions about patient dispositions are made after comprehensive psychiatric evaluation, treatment, and a recovery period in the unit's setting.

These units combine the calming, supportive atmosphere of community crisis clinics with the capacity to admit even the most acute psychiatric patients. EmPATH units have shown significant improvements in outcomes, safety, and patient satisfaction. They have also substantially reduced the need for coercive measures, instances of agitation and physical restraints, and unnecessary psychiatric hospitalizations, all while being more cost-effective than the traditional approach. The fiscal benefits of emPATH units include reduced boarding costs and unnecessary hospitalizations, while also freeing up ED beds for other medical emergencies.

EmPATH units exhibit diversity in their designs, staffing, and layouts, but they adhere to several core principles:

  1. A central, comfortable milieu room where patients are situated. Instead of individual beds, patients have their own recliner chairs allowing for social interaction or solitude.
  2. Staff presence is integrated into the milieu, ensuring quick and supportive assistance without a glass-enclosed nursing station.
  3. Prompt psychiatric assessment and treatment implementation to achieve better outcomes.
  4. The combination of prompt assessment, treatment, and a supportive environment leads to remarkable results, reducing the need for physical restraints and forced medications.

The effectiveness of EmPATH units has been demonstrated nationwide in acute behavioral crisis situations, with data indicating that up to 80 percent of patients can achieve stability within 24 hours.

After the University of Iowa, Health Care opened such a unit in its main hospital building in Iowa City, the number of suicidal patients admitted and the length of time they waited in the ER dropped dramatically.

This innovative approach has the potential to transform mental health care by reducing involuntary hospitalizations and improving patient outcomes.

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