Nebraska Medicine to open adult psychiatric emergency service

One in every eight visits to an emergency department in the United States involves a patient with psychiatric or substance use issues. Many of these patients wait hours or even days for transfer to inpatient psychiatric facilities. And this problem is only getting worse.

“We’ve seen a huge increase in mental health and substance use visits to our emergency department over the past four years,” said Howard Liu, M.D., chair of the UNMC Department of Psychiatry. “From 2015 to 2019, we saw nearly an 80% increase in people with a psychiatric crisis coming to our emergency department, and had more than 3,000 visits for this reason last year alone.”

It’s for this very reason that Nebraska Medicine plans to open a new Adult Psychiatric Emergency Services unit this fall to address these problems. The facility will be located on the ground floor of Clarkson Tower on the Nebraska Medical Center campus.

“The time is right to provide this service to our community,” Dr. Liu said. “The Adult Psychiatric Emergency Services will provide immediate care by licensed mental health providers in a safe setting. It won’t be the final destination for a loved one in crisis, but a safe and caring place to assess their needs, start treatment and then transfer them to an appropriate level of care.”

The unit itself will feature a calm, compassionate environment away from the main emergency department. The goal: to stabilize patients and swiftly refer them to community partners for appropriate treatment while avoiding unnecessary inpatient admissions.

Patients could be transferred to a number of settings: inpatient care, partial hospitalization, intensive outpatient services, or ambulatory care. The unit will be staffed by psychiatrists, advanced practice professionals, psychiatrically-trained nurses, psychiatric social workers and patient care technicians. Mental health patient advocates known as peer professionals have been engaged in the design of the unit and will be available to patients eight hours per day, to maximize dignity and respect for patients and families.

“Nationwide, these units have demonstrated the ability to lower inpatient admission rates. We know not all patients benefit from a hospital stay. It’s often better for patients who aren’t dangerous to themselves or others to continue their care with community-based providers,” said David Cates, Ph.D., director of Behavioral Health at Nebraska Medicine. “In addition, due to our close working relationship with and proximity to the Nebraska Medicine Emergency Department, we will be able to manage patients with complex medical needs, such as substance use withdrawal, medical clearance after a suicide attempt, or serious mental illness in combination with a coexisting medical diagnosis.”

Once open, Adult Psychiatric Emergency Services will consist of four interview/triage rooms where patients will have a trauma-informed mental health assessment performed. Low-risk patients may receive crisis intervention and then be released.

The unit also will have an open observation area with a capacity for 12 moderate-risk patients. These could be people with suicidal thoughts, manic symptoms from bipolar disorder, or substance use withdrawal who aren’t in danger of hurting themselves or others. Patients in this area could receive treatment such as crisis intervention, motivational interviewing, safety planning and discharge planning.

Finally, the unit will feature a “secure care area” consisting of six private rooms. This will be a safe place to stabilize patients who are at high risk for harm to themselves or to others or are too agitated to be around other patients while they wait for transfer to an appropriate facility.

Adult Psychiatric Emergency Services will accept all patients with mental health needs regardless of insurance, history of admissions, and history of violence as long as they are medically stable. It is primarily designed for adults, but can accommodate children and teenagers as needed. Patients may walk in or be taken by ambulance or law enforcement. Patients with an acute medical issue will be treated in the medical emergency department and then transferred to the PES when stabilized.

“Establishing this unit will propel Nebraska Medicine into a circle of national leaders,” said James Linder, M.D., CEO of Nebraska Medicine. “Using the best evidence available and putting it to use in a model that works will allow us to provide the highest standard of emergency psychiatric care and fill an important complementary need in the community.”