Integration with Community Resources

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Behavioral Emergencies for Healthcare Providers


In the United States, emergency departments (EDs) have become primary sites for emergent psychiatric evaluations and crisis intervention. These types of ED visits have been steadily increasing per year and have been found to have significantly longer lengths of stay than for non-mental-health-related visits. Recent data demonstrate a discrepancy in disposition options for mental-health-related complaints as compared to nonmental illness presentations in the ED, with presentations due to mental illness having disproportionately higher rates of hospital admission (Figs. 40.1 and 40.2). ED staff treat acute medical emergencies (e.g., cardiac arrest, stroke, and pulmonary embolism), diagnose and manage new-onset illnesses, and evaluate exacerbations for chronic diseases (congestive heart failure, diabetes, and chronic obstructive pulmonary disorder), understanding that not all sickness requires inpatient medical admission. As the number of mental health presentations continues to increase, ED staff need an understanding of and access to alternative community resources to avoid the exclusive use of hospitalization as the disposition choice for mental health crises. Lack of safe, nonhospital interventions leaves ED staff to over-rely on inpatient levels of care. This, in turn, contributes to the decreased availability of inpatient beds for significant crises, subsequently increasing psychiatric boarding.



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