By Dorothy Brooks
The EmPATH model is not a solution to every mental health issue. Rather, it is specifically designed to treat higher-acuity behavioral health (BH) patients, a segment of the mental healthcare spectrum that is lacking in many communities. “Someone who comes in for a refill [on their psychiatric medicines] or wants to be connected with mental health services doesn’t need to go to EmPATH. That is someone who can be helped right there in the front of the ED, possibly by a social worker,” says Scott Zeller, MD, the architect of the EmPATH model. “That is not an emergency.”
Zeller advises emergency leaders to consider key metrics, such as the average length of stay of psychiatric boarders. He says departments interested in EmPATH should be averaging more than six psychiatric boarders per day.
Administrators also should determine if there are other ways to accelerate care for BH patients. “For example, could you use a behavioral health specialist in the ED to help get things started more quickly? That can work [for EDs] with smaller numbers of these patients,” Zeller offers.
When deliberating, remember the busy, noisy environment of the ED often makes symptoms worse for patients who have presented with psychiatric emergencies. “They feel a lot better if they can move around or even pace in some cases. You can’t do that in the ED,” Zeller observes.
That is why many EmPATH units with which Zeller has been involved consist of designated open spaces where the patients are free to roam around while under observation. In some units, there are even outdoor gardens where patients can breathe fresh air or meditate.
Environment can make a significant difference when people are distressed. For instance, in typical EDs, Zeller says staff often turn to sedation and restraints. “In an EmPATH unit, generally one or two out of every 1,000 patients is placed in restraints,” Zeller reports. “There is that much of a change in how people feel and how people respond with more prompt attention and treatment — and a more comfortable setting.”
The EmPATH term is not trademarked, so healthcare organizations are free to use the concept as they see fit. “I am very happy that the model has gotten legs on it, people want to do these things, and they recognize the value,” Zeller says. “It is better for our patients, and usually better for the healthcare systems.”
When deliberating, remember the busy, noisy environment of the ED often makes symptoms worse for patients who have presented with psychiatric emergencies. Many EmPATH units consist of designated open spaces where patients are free to roam while under observation.
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