Behavioral health patients often face long wait times in emergency departments, where limited resources and a shortage of specialists can delay care. As these patients await treatment or placement, the departments can become overcrowded and overwhelming for those in a behavioral health crisis.
This is why the Medical University of South Carolina in Charleston is expanding emergency psychiatric alternatives across the state called emergency psychiatric assessment, treatment, and healing units, including what it says are the first units for children. Lalithkumar Solai, MD, chief of mental health at MUSC, told Becker’s the goal of the units is to move behavioral health patients out of overcrowded emergency departments, shorten wait times and avoid unnecessary hospitalizations.
“If we can move them into a safe space, like an EmPATH unit, then even before the clinician comes and sees them, the therapeutic environment that they are in should help in kind of calming them down, and hopefully will help them stabilize better,” he said.
In January 2022, South Carolina Gov. Henry McMaster called on the state Department of Health and Human Services to review the state’s behavioral health funding and delivery system. MUSC then received $100 million in government-allocated funds to build the Jean and Hugh K. Leatherman Behavioral Care Pavilion, which features EmPATH units.
Dr. Solai said therapists in the units can teach patients coping skills and help them reconnect with reality, which in turn frees up space in emergency departments.
“A patient comes in after a breakup with a girlfriend and is distraught, is suicidal — usually they end up in the hospital,” he said. “If you have an EmPATH unit where you can stay up to 72 hours, you kind of help them regroup themselves … help them pull themselves out of that moment of crisis … so that they don’t become suicidal and they could be reintegrated into the community. So your admissions to inpatients will go down.”
The model also has been implemented at Charleston-based MUSC Shawn Jenkins Children’s Hospital, allowing families to avoid the inpatient unit, where patients can be violent and aggressive.
“We were the first ones … to start a child EmPATH unit, and we have been running it since April,” Dr. Solai said. “Even in a crisis, when they’re having a breakdown … inpatient can be pretty traumatic for [children]. … So we try to avoid [inpatient] at any cost, and see if we can keep them briefly for a day or two in the EmPATH and send them back into the community.”
The system is seeing promising results, though data collection is still in its initial phases. In MUSC’s emergency departments, 50% of patients were admitted to inpatient care and 50% were sent back into the community. Dr. Solai said he hopes to see a significant shift in those numbers to 60% or 70% of patients being reintegrated back into the community.
Some challenges include needing the space to build out the therapeutic environment where patients can participate in group therapy, listen to music and relax, Dr. Solai said. Another challenge is that not every behavioral health patient qualifies to be placed into the EmPATH unit; that group includes “actively violent” or “actively psychotic” individuals.
Dr. Solai said the program’s success largely will come down to payer support.
“We can do all of these things, but if the payers don’t pay, then it’s not going to be a sustainable model five years from now,” he said. “Medicaid does reimburse for that model, which is … critical.”
