An individual experiencing a behavioral health crisis walks into the emergency department. Instead of lying on a gurney in the hallway or sitting in a chaotic waiting room, they’re led to a recliner chair in a calm environment and seen by a psychiatric provider typically within the hour.
That’s the idea behind Emergency Psychiatric Assessment, Treatment and Healing, a model of care that a growing number of health systems are betting can help fix one of the most fractured corners of emergency medicine.
EmPATH is a dedicated unit, separate from the ED, built for patients in a mental health or substance use crisis. Rather than boarding for hours or days, patients move into a calmer, more open environment where a psychiatric team can assess, stabilize and often discharge them — sometimes without ever being admitted to inpatient care.
But the model is more of a framework than a blueprint. Hospitals that run EmPATH units are quick to point out that no two look exactly alike — the capacity, the staffing overnight, the intake rules all vary by system.
1. The setup
An EmPATH unit’s location varies by system: it can sit within the ED itself, as with Charleston, S.C.-based MUSC Health’s unit, or offsite in a separate facility, as with University of Kentucky HealthCare’s unit near Eastern State Hospital in Lexington. At UK HealthCare, patients are offered a recliner chair in an open, low-stimulation space, often with access to an outdoor patio, group activities and space to move around rather than stay confined.
At MUSC, the EmPATH unit comprises eight bays inside its behavioral care pavilion. For UK HealthCare, its EmPATH unit has expanded from 12 chairs to roughly 20 since it opened. A community mental health center is also co-located to the unit to help patients schedule follow-up care before they leave typically within 24 to 48 hours of discharge.
Patient stays are short and structured. MUSC’s units allow up to 72 hours for adults, while UK HealthCare runs on a 23-hour observation window. Both approaches share the same goal: stabilize the patient quickly, then either send them home with follow-up care lined up or transition them to a longer-term facility.
2. Treatment
EmPATH units are designed for a broad range of behavioral health crises. UK HealthCare’s unit lists conditions including anxiety, bipolar disorder, depression, post-traumatic stress disorder, schizophrenia and other psychoses, substance use disorder, and suicidality. Suicidal ideation alone accounts for almost 60% of the patients who come through its doors. Patients arrive by ambulance, police transport, family, rideshare, bus or on foot. The units run 24 hours a day.
Treatment inside the unit is meant to be comprehensive but short-term, built around stabilizing the patient rather than working toward a long-term diagnosis. At MUSC, that includes medication, individual and group therapy, and crisis intervention aimed at addressing the immediate problem before it worsens.
UK HealthCare’s unit takes a similar approach, layering in peer support services, education and coping-skill activities alongside medication and therapy, with patients able to spend time in an outdoor patio or calming room rather than a traditional exam room. The system leans on peer support specialists in particular — staff with their own lived experience of mental illness or substance use — as a resource typical EDs do not have.
The inclusion criteria for a unit, though, varies significantly by health system.
3. Lessons learned from MUSC
When MUSC opened an adult EmPATH unit in July 2025, the system initially struggled to fill it. Daily utilization sat around 12% for the first six months, according to Lalithkumar Solai, MD, the health system’s chief of mental health. Clinicians kept defaulting to the ED’s behavioral health holding space out of habit. Staff were searching for an “ideal patient” for the new unit — one that, as Dr. Solai put it, didn’t really exist.
MUSC eventually flipped its default: starting in July 2026, the EmPATH unit became the primary space for psychiatric patients in the ED, with the other holding pod serving as backup for patients who need seclusion. The system also brought in a consulting team for an operational review. As a result, the system overhauled overnight psychiatric coverage so the unit has round-the-clock support instead of leaving patients unattended after 11 p.m. The changes have pushed utilization up from 12% to close to 40%, and cut the average ED stay for behavioral health patients from 20 to 22 hours down to 12 to 13 hours.
MUSC has also extended the model to children, opening what it describes as one of the first pediatric EmPATH units in the country.
4. UK HealthCare’s journey
UK HealthCare’s version of the model looks different by design. Where some EmPATH units screen out aggressive or violent patients, UK HealthCare’s unit was built to accept them. Marc Woods, DNP, RN, chief nursing officer for Eastern State Hospital, the EmPATH unit and the Good Samaritan behavioral health unit, said implementation of the model varies so widely from system to system that “if you’ve seen one EmPATH, you’ve seen one EmPATH.”
UK HealthCare’s version runs on what leaders call inclusion criteria. They described how essential building rapport with patients was by offering food and drink upon arrival, allowing patients to keep their clothes and belongings and watching closely for signs of escalation. That approach has kept restraint use on the unit below 0.01%, according to Lindsey Jasinski, PhD, chief administrative officer and director of psychology services at Eastern State Hospital.
The results have been substantial. In its first year, the unit drove a 63.5% reduction in inpatient psychiatric admissions and cut ED boarding time tied to its opening by more than 92%. Patients who once cycled through the ED an average of 5.5 times every six months are now returning to the EmPATH unit about twice in that span, and follow-up appointment attendance after discharge has more than doubled, from 29% to 65%.
5. The payoff and the open questions
Across both systems, the pattern is similar: fewer patients boarding in the ED, fewer unnecessary inpatient admissions, and staff who describe less of the burnout tied to what one UK HealthCare ED physician called the “moral injury” of wanting to help psychiatric patients but being stuck without the right space and tools to do so.
But the financial picture is unclear. MUSC currently receives an hourly Medicaid rate for a patient’s first 24 hours in its unit, followed by a daily rate around $400 — a marked improvement over being paid nothing for patients who were previously just boarding. But it is not enough, by Dr. Solai’s own account, to guarantee the model is sustainable five years out without stronger payer support. UK HealthCare, meanwhile, has proposed using federal rural health transformation dollars to fund more EmPATH units across the state over the next five years.
6. The sustainability problem
Even health systems that consider their EmPATH units a clinical success are candid that the financial model presents challenges.
MUSC has now opened seven EmPATH units across South Carolina as part of a broader push to expand behavioral health access statewide, but Dr. Solai said the funding stream to support them long-term is still being worked out. Without a clearer path to sustainable reimbursement, he said, the units could eventually be at risk of closure.
The problem isn’t unique to EmPATH. Dr. Solai pointed to other behavioral health programs, including Collaborative Care Management and Primary Behavioral Health Integration, as facing similar reimbursement gaps. Academic and state-supported hospitals in particular struggle with inpatient behavioral health reimbursement, he said, since current payment structures give health systems little financial incentive to offer many essential services — even when those systems view the care as necessary. That leaves hospitals absorbing part of the financial risk themselves, often propped up temporarily by donor funding that eventually runs out.
Dr. Solai’s conclusion: the field needs a comprehensive funding plan that covers the full continuum of behavioral healthcare — inpatient, emergency psychiatry, outpatient and intensive outpatient — in a way that can actually hold up over time. Until that exists, the expansion of EmPATH units nationally may keep outpacing the payment systems built to sustain them.
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