The demand for emergency behavioral health services has been rising steadily, and it’s estimated that more than 16% of total emergency department (ED) visits are from patients with one or more mental health or substance use disorders. Despite this demand, many health systems are ill-equipped to manage behavioral health emergencies. One survey found nearly two-thirds of hospital EDs do not have psychiatric staff caring for patients who require mental health services.

Health systems are increasingly providing focused psychiatric care to improve patient outcomes and reduce strain on their emergency departments. Spearheading this necessary shift are healthcare leaders like Dr. Herbert Harman, Regional Director at Vituity, a physician-led and -owned multispecialty partnership. Dr. Harman and the team at Vituity help health systems across the country develop programs that deliver acute psychiatric care to patients in a less stressful, restrictive setting than the ED.

We sat down with Dr. Harman to learn more about his work and what health systems that want to transform their emergency behavioral health services need to know.

What barriers do health systems face in providing acute behavioral health care?

Health systems and physicians who provide acute behavioral health services face numerous challenges, according to Dr. Harman:

• Insufficient inpatient psychiatry beds: Psychiatric patients often wait an average of 7 to 34 hours in EDs for an available inpatient psychiatry bed, which can cause symptoms to escalate without proper, focused behavioral health treatment.
• Lack of ED resources: These longer ED stays can overburden physicians and staff and reduce the ED capacity for patients in need of emergent care. One study found only 17% of emergency physicians had access to an on-call psychiatrist.
• Over-reliance on in-person care: Health systems and providers are often incentivized by payers to only see patients in-person, which severely limits the number of patients a psychiatrist can see and introduces barriers to care for many patients, like lack of reliable transportation. Reimbursement is often also tied to rules based on where the physician is located and the patient’s insurance that may further complicate the process.

What is Vituity’s model for effective acute behavioral health care?

Many of the challenges listed above can be alleviated by creating a unit outside of the ED where patients having a behavioral health crisis can receive care on an outpatient basis. When working with health systems like AVIA Member Providence, Dr. Harman and the team at Vituity recommend creating crisis stabilization units (CSUs), which they call EmPATH units.

EmPATH (Emergency Medicine Psychiatric Assessment, Treatment, and Healing) units provide patients with full-time, immediate access to a psychiatrist for evaluation and treatment, helping manage psychiatric crises outside of the ED and ensure coordinated and specialized treatment and post-release planning and care.

These care units often have a maximum length of stay of 24 hours, and 75% of patients are discharged within that time frame, demonstrating that patients can often be stabilized more quickly in less-restrictive outpatient settings. The units can improve ED throughput, reduce inpatient admissions, minimize ED overcrowding, improve discharge procedures, and improve long-term patient outcomes.

What are the components of a successful behavioral health program?

When working with health systems to establish an effective behavioral health care program like an EmPATH unit, Dr. Harman focuses on three key components that are foundational to building the program:

1. Flexible technology: Health systems should have an EHR that makes it easy for visiting or on-call psychiatrists to access patient files when they need it.
2. Well-organized operations management: To maximize the value to the patient, operations staff should be in place to manage patient flow from the ED, ensure patients are awake when being seen by psychiatrists, and minimize the amount of time physicians need to be in court testifying in patient care cases.
3. Strong relationships with patients: Patient perception of hospitals hinges on the relationships they have with the doctors and staff. Effective communication, cultural sensitivity, and the absence of coercion result in increased trust and improved outcomes.

What is digital’s role in the future of behavioral health services?

Telehealth has been gaining popularity in the behavioral health field, used to consult with emergency physicians, collaborate with crisis teams, virtually staff EmPATH units, and serve patients in shortage areas.

According to Dr. Harman, COVID-19 further accelerated virtual care in behavioral health. He predicts payers will have to shift their model from incentivizing in-person care to allowing patients and physicians to provide virtual care when appropriate. Dr. Harman acknowledges the barriers that will have to be overcome, like ongoing provider resistance and inequitable access to technology.

If you are a health system looking to establish an acute behavioral health care program and would like to know more about Dr. Harman’s work, contact AVIA today for more information.