Service Models for Urgent and Emergency Psychiatric Care: An Overview

Abstract

There is variation in the way mental health services respond to urgent and emergency presentations, with few evidence-based models reported in the literature, and no agreed on best practice models. To inform the development of urgent and emergency psychiatric care models, a literature review was performed. The review sought to identify strengths and critiques of varying models, evidence gaps, and areas for future research. After review, significant variation was found in the design and scope of urgent and emergency care models. Most models are either community or hospital based, with few integrated models that span community and hospital care. The development of integrated models has the potential to reduce service duplication and support a shift toward provision of least restrictive care. The overall evidence base of urgent and emergency care models is limited, with few studies in the area, and there is a need for further research. [Journal of Psychosocial Nursing and Mental Health Services, 56(8), 23-30.].

Characteristics and outcomes of patient presentations made by police to an Australian emergency department

“…Strategies such as co‐responding police and mental health teams have shown some benefit in reducing pressures on the justice system, injury rates, arrests and hospital handover time . Other strategies include better access to outreach crisis mental health clinicians, and community alternatives to hospital ED care . While these strategies may be helpful in responding to people in the community in crisis, inter‐agency, larger scale public health prevention efforts targeted at youth with or at risk of mental health crisis also warrant further exploration.…”

Mobile care service for psychiatric urgencies and emergencies: perception of nursing workers

“…It should also be noted that one of the relevant aspects in the practice of nurses working in psychiatric emergency, which contributes to the production of dehumanized and mechanistic health actions, refers to the difficulty of co-responsibility for care and wage inequality in relation to medical category. In general, they use as an argument the lack of autonomy and the submission of nursing work to medical work (42) .…”

“…The author points out that nurses demonstrate difficulties in defining the work object in the paradigm of Psychiatric Reform, that is, in this mental health team, which defines as subject of intervention the subject-citizen in their psychosocial needs, the nurse is not defined as subject -worker (42) . Thus, one can inquire what is the condition of this professional to conduct themselves in relation to a care whose orientation is the social reintegration of the person with mental disorders when he himself does not position himself in the team as a citizen-subject.…”

“…Therefore, the nurses' performance is essential for the proper management of the multidisciplinary team and the process of constructing emergency care in mental health. In addition, the need for readjustments in the psychosocial care paradigm and emphasis on actions on nursing performance have considered the legal aspects of care management offered to the person with mental disorder and his/her family (42) .…”

An examination of the profile and journey of patients with mental illness in the emergency department

“…Hospital emergency departments (EDs) play a role in treating people with mental illness (1,2). Despite efforts to care for people with mental illness in the community, away from hospitals, people with mental illness continue to present to EDs with both emergency and non-emergency mental health problems (3)(4)(5).…”