If your care team in the medical emergency room (ER) decides you need more care than they are able to provide or coordinate for you, they may transfer you to a center that specializes in psychiatric urgent or emergency care.
These centers typically follow one of 2 different models:
1. A psychiatric emergency service (PES)
2. A crisis stabilization unit (CSU)
ERs transfer to a PES or CSU if they are concerned that you will need more than 24 hours of urgent psychiatric care. They will also transfer if they are concerned you may need the support of a staff and a facility that is geared primarily toward mental health.
One way to think about it is to consider that ERs are designed to treat many types of illness, and the staff have some mental health training. However, a PES or CSU is designed to treat urgent mental health needs all day, and is also designed to work closely with ER and hospital staff.
In general:
1. A PES tends to be a larger facility that has 24-hour staffing with at least one psychiatrist. Additionally, all the components of the medical team have mental health training, including the nurses, social workers, and the administrative staff. In urban areas, PESs tend to be associated with larger county or university hospital systems that can support more patients at a time and are equipped to handle more acute patients.
2. A CSU tends to be a smaller, more intimate facility. A common patient count is between 8-12 people admitted at a time. Many CSUs are designed around models that anticipate patients will be discharged home in 1-2 days. Psychiatrists are usually available on site only during the day, but there is a 24-hour psychiatrist on call.
As more hospital systems build sites to provide emergency psychiatric care, the lines between a PES and CSU are somewhat blurring. For instance, the PES for a rural community may actually be smaller and have less services available than a CSU in an urban center.
I often hear patients express that they are frustrated with being transferred to a second facility after waiting for hours for medical clearance in an ER. Their frustration reflects many truths about ER care, because the wait in the emergency room can be long and frustrating. If you are completely new to accessing urgent psychiatric care, it can also be overwhelming to have to learn about so many new terms and processes.
I try to encourage reframing the transfer as an opportunity to help make sure that your urgent psychiatric needs are addressed by specialists in a care environment tailored for mental health needs. So while the process might be frustrating, the end goal is very often worthwhile.
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