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05/21/2019

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Beyond Boarding: A New Paradigm for Mental Healthcare in the Emergency Department

Individuals with mental health or substance-use related issues are one of the fastest-growing patient populations in U.S. hospital emergency departments.

This surge is creating a crisis for some hospitals. Without adequate access to behavioral health specialists to perform mental health evaluations or readily available psychiatric beds for admission, these patients often hold or board for hours, days and even longer, often without receiving the specialized psychiatric care they need.

When asked how a busy emergency department can ensure that behavioral health patients get the care they deserve, Dr. James Horst, National Medical Director of Behavioral Health and Post-Acute Care, said removing the stigma from behavioral health patients and treating each visit as a new episode to evaluate, treat and advocate for the patient is key. Emergency departments (ED) can become fatigued with behavioral health patients based on their “frequent flyer” status. Behavioral health patients often cannot navigate the health care system and end up in emergency rooms due to the police bringing them or not having the ability to find a non-ED treatment option. Emergency department leaders need to educate their personnel based on behavioral health patient limitations and encourage standard medical approach regardless of patient population. In addition, ED leaders need to get involved in behavioral health advocacy with their hospital partners as well as with local and national post-acute care providers.

Some healthcare experts have described the state of behavioral health care in emergency rooms as a crisis based not only on patients’ needs and capabilities but also their lack of financial stability. Behavioral health patients that use the emergency room for their care routinely have delusions, hallucinations and have a high rate of chemical dependency. This makes their needs very complex; however, their capability to follow treatment recommendations are often very poor. They are frequently unemployed or underemployed at best. This often leads to poor or no coverage for basic treatment let alone more intensive inpatient treatment. High complexity plus poor treatment adherence plus very limited treatment options equals a crisis.

Currently, TeamHealth is working with our hospital partners to improve the level of care for behavioral health patients by offering regional mental health education to emergency department clinicians and other initiatives that will make a greater impact. We are promoting a pilot “psychiatric hold unit” at one of our emergency departments, and we are also vetting a telemedicine platform that may prove very positive. Lastly, we are also working as a national advocate for behavioral health patients, giving them a voice they desperately need.

There are multitudes of factors that have led to this situation, and hospitals cannot solve the problem alone. They can, however, make some fundamental changes to the way they approach and treat patients with behavioral health conditions while boarding in the ED to improve their care and, concurrently, expedite patient flow.

Click here to read our full white paper discussing a new approach to treating behavioral health patients in the ED.

To learn how TeamHealth can help implement new behavioral health strategies in your emergency department, call 818.1498 or email us at business_development@teamhealth.com.