“The emergency department is the gateway to care,” said Ng, medical director of Arcadia Health System in Bangor, Maine. “This is where they’ll get their first impression of psychiatry, so even if they’re not ready to accept treatment, we can prepare them for that moment.”
Traditionally, emergency department psychiatry worked on a “triage-and-refer” model. Now an alternative approach (at least for some patients) can see the first stages of treatment there, although not without some major adjustments. For instance, the practical concerns of operating an emergency department creates a sense of urgency that is at odds with the usual paradigm of psychiatric care, said Ng.
“You have to do recovery work in minutes or hours versus days or months,” he said. But there can be a payoff if that effort reduces use of restraints or leads to fewer readmissions and trips back to the emergency department.
Engaging patients long enough to figure out what they really want when they approach the hospital may reveal that alternatives like day hospitals, crisis teams, or even phone calls may meet their real needs and cut unnecessary usage.