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What Psychiatrists Need to Know: Patients in the Emergency Department – Psychiatric Times [2018-08-16]

“If you’re having a psychiatric emergency, hang up and dial 911, or go to your nearest emergency room.” Most psychiatric patients are all too familiar with this voicemail message. And those who follow this advice, even calling 911, will still likely find themselves at the nearest emergency department (ED).

What many psychiatrists do not realize is that the majority of EDs in the US are inadequately equipped to treat psychiatric crises. As a result, many patients who seek emergency psychiatric care are mostly held for transfer to inpatient facilities. In fact, patients who present to the ED with mental health and substance abuse complaints are 2.5 times as likely to be admitted as those with purely physical problems.1

Unfortunately, the demand for inpatient psychiatric beds far exceeds supply. The Treatment Advocacy Center reported that the number of inpatient beds dropped by 95% from 1955 to 2005, going from 340 beds per 100,000 people to 17 beds per 100,000 people—and the number is still dropping.2 Because of this shortage, admitted patients must often wait many hours in the ED without treatment. This practice is known as psychiatric boarding.

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Scott Zeller, MD, Psychiatric Times, August 16, 2018