Behavioral Health in the ED

You begin your rounds for the evening ER shift. The screaming toddler in bed one has a painful ear infection. The parents worriedly hover over their crying child, trying to soothe her. Bed two, an elderly patient you’re worried is having a heart attack; you double check the nurse is doing the EKG now. The patient in bed three catches your eye on the way over to another consult. They have been waiting to be moved to the behavioral health ward since your last shift. You are familiar with this patient, you see them in your emergency department every few weeks. They stopped taking their schizophrenia medication again.

When they came in, they were agitated and distressed. Numerous cuts and scrapes covered their arms. Likely from a struggle with the family that brought them in. You bandaged them up, but you don’t know which medications they were on. A call was put in to have them admitted, but the patient is still there over 24 hours later. You’ve done everything your training has prepared you for, but for this patient, it’s not enough. Sadly, these types of situations are not out of the ordinary for behavioral health patients.

ED physicians lack basic psychiatric training

Despite countless hours in training, many emergency department (ED) physicians are not prepared to treat patients with behavioral health problems. They lack even the basic training of how to approach patients with these conditions. Neither the Accreditation Council for Graduate Medical Education (ACGME) nor the American Board of Emergency Medicine specifies psychiatric program requirements as part of an emergency physician’s core training.

Fewer than 24% of emergency medicine training programs provide any psychiatric training at all, and less than 3% provide training for emergency pediatric doctors.

In fact, fewer than 24% of emergency medicine training programs provide any psychiatric training at all, and less than 3% provide training for emergency pediatric doctors. Physicians’ lack of training is at odds with the reality they face. 1 in 8 patients at the ED has a mental health issue as their primary complaint.

Perhaps because of this lack of training, ED physicians see behavioral health patients as difficult to treat, and often report that they do not enjoy treating them. Even to the point of some physicians being angry at the patient. These negative attitudes and the damaging impact they have on patient care have been recognized for decades. But still, the lack of training persists.

As we learned in our previous post, correctly assessing mental health disorders in an ED can be challenging. Not only do these patients often present with confusing physical symptoms, they can also easily get lost in the system. The nature of emergency medical care makes physicians’ days and patients’ needs unpredictable.

Telepsychiatry can fill in the gaps where ED training leaves off

Telepsychiatry can help solve these issues. Telepsychiatry helps ED doctors by giving them access to board-trained psychologists and behavioral health specialists. MindCare carefully selects mental health specialists, including board psychiatrists, nurse practitioners, licensed clinical social workers, and counselors who are well versed in behavioral health patient care and standard operating procedures in the ED. MindCare works to streamline communication and coordination between ED and mental health providers.

There is substantial evidence demonstrating that telepsychiatry provides equivalent care to in-person visits. Both patients and healthcare professionals report high satisfaction with telepsychiatry services. Having psych-trained health professionals available to ED staff can help reduce the burden and potential harm caused by these gaps in emergency education.

Telepsychiatrists deliver quality care and help patients get the treatment they deserve

Telepsychiatry offers consistent, quality care, and timely access for patients. MindCare’s team can help determine the proper diagnosis, offer treatment recommendations, assist with patient discharge and placement, and even provide follow-up care. With MindCare, behavioral health patients can get the care and medical treatment they need. No more waiting around for a bed to open.

Until the education and training for ED physicians adjusts to fit the changing needs of emergency patient care, there will be behavioral health patients who do not receive the care they need. Telehealth psychiatric teams can fill in the gaps and help ensure every patient receives the care and medical treatment they deserve.