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The emergency care of behavioral health clients in emergency departments (EDs) is not as well developed as other types of emergency care. Most hospitals, even those, which have worked to improve ED flow overall, have not adequately tackled the behavioral health area. However, the behavioral health cohort in EDs is a significant subset of all patients, appears to be growing, and is often a source of concern and even embarrassment for hospitals and staffs. The behavioral health field has the same basic objectives and stages of care as the rest of medicine. The requirements are to

  • Establish hope—the therapeutic relationship
  • Treat for recovery
  • Maintain wellness

National statistics on ED visits are a poor indicator of the actual number of people with behavioral health problems who utilize the ED. Further, these statistics do not account for the impact of their presentations or the number of people whose problems have a secondary relation to behavioral health. The number and percent distribution of ED visits by the 20 leading principal hospital discharge diagnosis groups indicates about 2.4% of discharges have a diagnosis of psychosis excluding other major depressive disorders.1 Individual hospital data suggests about 8% of ED patients carry a behavioral health diagnosis, but the stigma of these diagnoses still causes many clinicians to hesitate identifying them as a primary diagnosis. Recently Pam Hyde, SAMHSAS Administrator, estimated that a quarter of all ED visits have a behavioral health component.

Psychiatric Illnesses Treated Differently during ED Visits

People with mental illness spend an average of 75 minutes longer waiting for, or receiving, treatment in EDs than do people with other illnesses. This may be due to perceptions that their conditions are less serious.2 There are many stories of people with a behavioral health problem waiting several days in a hospital ED for treatment or discharge. The Report of the Council on Medical Service of the AMA found the influx of patients with psychiatric illnesses seeking care in EDs has been identified as a trigger, exacerbating medical personnel shortages and causing ED overcrowding.3

One significant issue adding to the difficulty of serving behavioral health patients is that a high proportion of these patients arrive with previous thoughts of suicide. In a study published in General Hospital Psychiatry, Boudreaux and others found that over half of those who presented with behavioral health problems indicated they had at least thought about suicide.4 The extended boarding of psychiatric patients in EDs not only results in delayed and inadequate care for the mentally ill, but also increases the backlog of patients in the ED. Sixty percent of emergency physicians in the American Association of Emergency Psychiatry survey reported that the increase in psychiatric patients negatively affected access to emergency medical care for all patients.

Additionally, these physicians reported that ED staff spends more than twice as long obtaining inpatient beds for psychiatric patients ...

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