An emergency psychiatric evaluation is not complete until the care team knows the answer to a key question: After you leave emergency services, where is it safe for you to go next?
Typically, the options fall into three categories.
Option 1: Home
Just like any other trip to an emergency room, sometimes things are easily resolved and it's safe to send a person home. Before discharge, the treating physician will provide education on recommended next steps and places the patient might present for outpatient follow-up appointments.
If safe and appropriate, the patient may also be given a short term prescription to help them cover the time until they see their established outpatient psychiatrist or their primary care provider.
Option 2: Urgently Coordinated Outpatient Care
This category encapsulates a large range of options, and those options change based on the community a person lives in.
Some large managed health care organizations have set up referral systems. If a patient in their healthcare plan has recently been discharged from the ER, that patient is offered a standard outpatient psychiatry appointment within 24-48 hours of discharge.
Some communities also have mental health programs that can accomodate urgent intakes. While an appointment with a psychiatrist may not be available immediately, a patient can still be enrolled, start to see a therapist, or start a group within a few days.
There are also options for care that are meant to be a middle ground between outpatient care and hospitalization. These programs are typically called Intensive Outpatient Programs or Residential Care Centers. Both of these types of programs are designed to help patients that may need care over several days or weeks, but are not so acutely ill that they would meet criteria for psychiatric hospitalization.
Option 3: Hospitalization
Hospitalization might be chosen for logistical or clinical reasons.
Sometimes the ER will attempt to organize outpatient care and aren't able to do so. This can happen for a variety of reasons. However, if the care team at the ER does not think the patient is well enough to discharge home without a clear provider and a plan in place, then they will ask a psychiatric hospital to admit the patient in order to continue care planning and coordination.
Sometimes a patient requires continued testing, evaluation, or treatment that is only available at psychiatric hospitals. For example, if it is clear that the patient is struggling with a severe challenge, but the diagnosis is outside of the skillset of the ER team, then emergency services will admit the patient to a psychiatric hospital for a higher level of care.
Sometimes a patient will refuse recommended care, but all the available evidence indicates that the patient would not be safe if they were discharged home or to a lower level of care than hospitalization. In these cases, ERs will transfer to a psychiatric hospital. Not only can the psychiatric hospital continue clinical care, but psychiatric hospitals are also better able to coordinate with local legal organizations to determine how best to proceed in these situations.
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