For over a decade, we have been experiencing an ever-growing mental health crisis. Currently, 1 in 5 U.S. residents live with a mental health disorder and less than half of these individuals received mental health care.1 This trend has taxed a limited number of behavioral health services/resources for years and has resulted in individuals not receiving timely or appropriate care. This trend has also led numerous psychiatric professional organizations and hospital associations across the country to declare a national mental health emergency.2
One important characteristic of this crisis is the overutilization of Emergency Departments (EDs) to serve as both an emergency resources as well as the front door to all behavioral health services. For example, over the last 7 years, there has been a five-fold increase in the number of patients admitted to emergency departments for mental health disorders.3
However, EDs are not equipped for the current public health need. In California alone, there is an average of 2,143,614 mental health ED visits annually and anywhere from 13-15% of all ED visits nationwide are mental health oriented.3,4 This results in multiple struggles for hospitals and patients, which include: extending the patient’s length of time of care, the ED’s inability to meet the mental health needs of the patient, ED environments increasing the patient’s level of stress, patients feeling like a burden to the hospital, and potential health inequities.5,6Furthermore, EDs are increasingly meeting this challenge with a practice known as boarding, which the Joint Commission (the accrediting body for hospitals) suggests leads to lower quality care and ultimately worsens ED crowding.7
In parallel, communities have been attempting to remedy this challenge with a host of new crisis resources including mobile crisis units, new mental health hotlines (e.g., 988) and crisis stabilization units. These new initiative have been promising in terms of increasing access in the community8 but one specific type of crisis stabilization model seems to offer a greater impact: Emergency Psychiatric Assessment Treatment and Healing (EmPATH) crisis stabilization units.
EmPATH crisis stabilization units are extensions of existing EDs. These unique units provide psychiatric care in an environment that is well suited for mental health patients. EmPATH units have been found to reduce the time patients spend in the ED, increase appropriate levels of care, increase follow up care and reduce recidivism.9
The state of California is investing in the expansion of EmPATH units through the California Mental Health Services Oversight & Accountability Commission (MHSOAC).10 In 2023, the MHSOAC has provided funding for 11 hospitals across the state to build these ED extension units. The MHSOAC is also funding hospital access to trainings and technical support in the development and operations of EmPATH units.
Although these resources are new to California, there are a handful of hospitals across the state that have been operating EmPATH units and have seen significant improvements in ED through-puts, reductions in boarding, as well as overall better care for mental health patients. In 2023, Loma Linda University Children’s Hospital and the Loma Linda University Medical Center were awarded grants to help support the construction of an adult and youth EmPATH units. It is estimated that these units will be operational in 2025. This new resource will greatly improve patient care and patient access to much needed mental health services.
Brian Distelberg, PhD
Dr. Distelberg is the Director of Research at the Behavioral Medical Center and is also a Professor of Counseling and Family Sciences for the School of Behavioral Health. His research interests include research methodologies; statistics; community and organizational systems; multivariate analysis; community-based research; and social and behavioral health.
- Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report
- American Academy of Pediatrics (2021): AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health. Retrieved Oct 2023 from: https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/
- Bommersbach TJ, McKean AJ, Olfson M, Rhee TG. National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020. JAMA. 2023 May 2;329(17):1469-1477. doi: 10.1001/jama.2023.4809. PMID: 37129655; PMCID: PMC10155071
- California Department of Health Care Access and Information (2023): Inpatient hospitalization and emergency department visits for patients with a behavioral health diagnosis in California: Patient Demographics. Retrieved Oct 2023 from https://hcai.ca.gov/visualizations/inpatient-hospitalizations-and-emergency-department-visits-for-patients-with-a-behavioral-health-diagnosis-in-california-patient-demographics/
- Cadorna,G., San Jaun, N.V., Staples, H., Johnson, S. & Appleton, R., Review: Systemic review and metasynthesis of qualitative literature on young people’s experiences of going to the A&E/emergency departments for mental health. Child and Adolescent Mental Health, Oct 2023. https://doi.org/10.1111/camh.12683
- Hoge, M.A., Vanderploeg, J., Paris, M. et al. Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda. Community Ment Health J 58, 1225–1239 (2022). https://doi.org/10.1007/s10597-022-00937-7
- The Joint Commission: Quick safety 19: ED Boarding of psychiatric patients – a continuing problem. Retrieved Octr 2023 from:hhttps://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety--issue-19-alleviating-ed-boarding-of-psychiatric-patients/alleviating-ed-boarding-of-psychiatric-patients/
- Saunders, H., Guth, M. & Panchel, N. (2023). Behavioral health crisis response: Findings from a survey of state Medicaid programs. Kaiser Family Foundation. Retrieved Oct 2023 from https://www.kff.org/mental-health/issue-brief/behavioral-health-crisis-response-findings-from-a-survey-of-state-medicaid-programs/
- Kim AK, Vakkalanka JP, Van Heukelom P, Tate J, Lee S. Emergency psychiatric assessment, treatment, and healing (EmPATH) unit decreases hospital admission for patients presenting with suicidal ideation in rural America. Acad Emerg Med. 2022 Feb;29(2):142-149. doi: 10.1111/acem.14374. Epub 2021 Sep 7. PMID: 34403550; PMCID: PMC8850530
- See https://mhsoac.ca.gov/connect/grant-funding-opportunities/request-for-applications-emergency-psychiatric-assessment-treatment-and-healing-empath-units-rfa-empath-001/