A growing number of emergency room visits are related to mental health emergencies, and hospitals are adapting to keep up.
One adaptation aims to carve out a therapeutic space amid a crowded and chaotic emergency department for patients experiencing a mental health crisis.
EmPATH — emergency psychiatric assessment, treatment, and healing — units, look more like a living room than an ER. Though they run differently from hospital to hospital, the units feature reclining chairs, rather than beds, in a shared space, or milieu. Nursing stations are open, rather than shrouded in plexiglass.
Inova Fairfax (Va.) Hospital is home to one of the newest EmPath units, which opened in November. Sonja Flood, director of Inova Behavioral Health, told Becker's the unit features 14 recliners, dim lighting, televisions and quiet spaces for patients who need to decompress away from others on the unit.
The environment is key to the EmPATH unit, she said, and the hospital put a lot of thought into designing the space.
"Not only are you providing observation, assessment, medication management, clinical interventions with nurses, techs and therapists — you're also creating a very open, homelike, therapeutic space," Ms. Flood said.
The model was developed by Scott Zeller, MD, former head of psychiatric emergency services at Oakland, Calif.-based Alameda Health System, in 2012. There are now dozens of the units across the country.
In EmPATH units, around 70% to 80% of patients who would require inpatient hospitalization at a typical emergency department are able to be stabilized and discharged after 24 hours, Dr. Zeller told Becker's in 2020.
Some states have moved to support EmPATh units through grant funding. In 2023, South Carolina approved $35 million in funding to hospitals to develop the units.
Lexington (S.C.) Medical Center was one such hospital that received state funding for an EmPATH unit. The hospital renovated a medical office unit near the emergency department to create the 14-bed unit, which opened in September.
Jay Hamm, vice president of operations at Lexington Medical Center, told Becker's some of the hsopital's staff, including himself, were skpetical of the EmPATH model — but the unit has delivered results so far.
According to Mr. Hamm, patients spend 12.1 hours in the EmPATH unit on average. Previously, patients experiencing a mental health crisis would spend an average of 26 hours in the emergency department waiting for a psychiatric bed.
The unit has also reduced the number of patients requiring inpatient hospitalizations has also decreased, Mr. Hamm said, from 70% prior to impolementing the EmPATH model to 44%. More patients are being sent home with outpatient referalls.
In addition to improving outcomes, the EmPATH unit has also created better job satisfaction for staff, Mr. Hamm said.
"It's a better area for the patients, the sataff also feel much more engaged in and responsible for helping this patient get to a different level of healing," he said.
Overlook Meidcal Center in Summit, N.J., part of Morristown, N.J.-based Atlantic Health System, opened an EmPATH unit in January. Over the course of the past year, the staff at the eight-bed unit has grown more attuned to patients' needs, Lori Ann Rizzuto, director of behavioral health services at Atlantic Health System, told Becker's.
"They're much more in tune, I think, as they're understanding what the patient experience has been, and what kinds of things we need to be focusing on," Ms. Rizzuto said. "How are we going to engage [patients] differently? What kinds of treatment planning exercises should we be doing? What should that curriculum look like? We put a lot of time and energy into it."
Support from hospital leadership, space and funding are key for developing successful EmPATH units, leaders told Becker's. The units can come with challenges — not every hospital has the space for a seperate EmPATHunit. The units often lose money, the New Yorker reported in 2023.
Despite a few challenges, leaders see the units continuing to expand. The National Council for Mental Wellbeing has called for hospitals to implement an EmPATH or similar model "wherever feasible."
"I would like to think EmPATH units wil be very, very common," Ms. Rizzuto said. "It's a game changer for so many patients."