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Pandemic highlights need for psychiatric EDs

Canada is in the grips of a mental health crisis. Between 2008 and 2019, emergency department visits and hospitalizations for mental disorders increased by 61 per cent and 60 per cent respectively, while hospitalizations for other conditions decreased by 26 per cent. The COVID-19 pandemic has amplified levels of stress, grief and isolation and highlighted how our health-care system continues to fall short on providing appropriate mental health care. Hospital emergency departments (ED) are not designed for mental health emergencies. The loud, bright and crowded environment can be overwhelming, isolating, anxiety-provoking and triggering.

Individuals visiting the ED for psychiatric reasons tend to wait twice as long as others since mental health emergencies are often not seen as a priority. Providing timely care is crucial for proper assessment and treatment of psychiatric conditions as many can be appropriately managed if early treatment is provided.

Moreover, patients who visit EDs for mental health and/or addictions tend to have four or more visits per year. If patients have a negative ED experience, they may not utilize this service again, even if critically needed.

Other than EDs, those in immediate mental health crisis can turn to helplines, family physicians and community mental health resources, but these options do not provide the same level of care. While helplines are available 24/7, they do not provide in-person care or perform medical assessments. Furthermore, there have been several incidences of helplines failing to meet callers’ needs. Appointments with family physicians generally need to be booked in advance and office hours are often limited. And community mental health resources have limited hours of operation and may be scarce in some areas.

In the United States, psychiatrist Scott Zeller led the development of the first EmPath unit (Emergency Psychiatric Assessment, Treatment and Healing unit). These units are specially designed emergency rooms for patients experiencing an acute psychiatric issue, including a psychotic episode or suicide attempt. The goal is to have patients seen quickly and discharged with the appropriate resources. The unit has an open concept, with comfortable reclining chairs, soft lighting and no locked rooms. Patients are free to come and go and have the option of staying up to 24 hours if needed.

EmPath units provide a new and innovative method of care by offering patients in crisis immediate access to mental health experts in a calm environment. Patients with mental health or substance use disorders are quickly triaged and guided to the EmPath unit. Here, they can receive compassionate care to stabilize their situation, reducing the likelihood they will need to be admitted into a hospital’s psychiatric unit.  

At least 20 hospitals have implemented EmPath units across the United States. Research points to a significant positive impact on the health-care system, including a 70 to 80 per cent decrease in hospitalizations for psychiatric needs, a 90 per cent decrease in mental health ED visits and an average of 16 fewer hours of stay in hospital for psychiatric needs. One facility that has an EmPath unit in place saved the ED $1 million, which was then used to open additional beds.

“It’s our job as mental health professionals to help our patients become self-sufficient,” says Lewis P. Zeidner, Minnesota Health Fairview’s clinical director of behavioural health care. “If patients can avoid hospitalization through the use of other care models, they can start using their new skills in their daily lives to build resilience. The goal is to help them get through the current crisis while equipping them with the coping skills they will need to handle future crises.”

In Canada, the Centre for Addiction and Mental Health (CAMH) in Toronto has one of the only existing 24-hour emergency walk-in centres to treat acute psychiatric issues.

But there is hope. The Ontario Shores Centre for Mental Health Sciences in Whitby has submitted a proposal to the province to become the first facility with an EmPath unit in Canada. The unit would include 32 recliner chairs and cost about $35 million to build and $12 million a year to operate. The proposal outlines that it would likely assist in saving more than $11 million in health-care costs and by 2027, it estimates that it will be treating 9,700 patients annually.

The proposal is still in its early stages. Ontario Shores is currently holding “a name a day” campaign in which it hopes to receive at least one signature a day to demonstrate the need for this service.

“The way we deliver mental health care has to change,” says President and CEO of Ontario Shores Karim Madmdani. “Our ED facilities are not optimized to provide urgent help to patients suffering from the most severe mental health issues and oftentimes worsen their symptoms and outcomes.”

Prior to the pandemic, the WHO identified chronic underfunding of mental health across the globe; now, we need these services more than ever before. Ultimately, having psychiatric EDs across Canada removes barriers in the diagnosis and treatment of mental illness and would allow for quicker access to care, all the while reducing overall hospitalizations and costs.

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Authors

Casandra Boushey

Contributor

Casandra Boushey is an MHA candidate at the Telfer School of Management and an occupational therapist at the Queensway Carleton Hospital.

Sarah Willms

Contributor

Sarah Willms is an MHA candidate at the Telfer school of Management, cardiac sonographer at CHEO and a professor for the Cardiac Sonography program at Algonquin College.

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