Emergency Psychiatry in an Extraordinary Age

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SPECIAL REPORT: EMERGENCY PSYCHIATRY

It is an amazing time to be involved in emergency psychiatry. Research, interest, and innovation in emergency psychiatry have reached unprecedented levels. For example, scientific submissions to the crown jewel of meetings in the field, the annual National Update on Behavioral Emergencies Conference, are up by nearly two-thirds over the previous conference’s record-setting numbers. Multiple academic centers now offer fellowships in emergency psychiatry, and there is talk of finally elevating the discipline to a boarded subspecialty.

Innovations in emergency psychiatry seem to arise almost daily, from high-technology solutions to humane reimaginings of traditional services. Even the mainstream popular press has noticed, exemplified by The New Yorker magazine’s recent feature, “Reinventing the E.R. for America’s Mental-Health Crisis.”¹

But as that title implies, it is an era with highly troubling challenges as well. Over the past decade, the percentage of behavioral emergency cases presenting to hospital medical emergency departments in the United States has almost doubled, with the COVID-19 pandemic making those numbers even greater.² Suicide deaths in the United States were at an all-time high of 49,000 in 2022, increasing by nearly 3% from 2021.³

This is affecting children as well as adults. Approximately half a million children with behavioral health conditions now present to US emergency departments each year, according to the American Academy of Pediatrics.⁴

Fortunately, these issues are being noticed by Washington. The Biden administration recently announced millions of dollars in grants to expand emergency psychiatry and crisis programs, improved Medicare reimbursement for urgent mental health care, and nearly a billion dollars to expand and fortify the 988 Suicide & Crisis Lifeline connection system.⁵

With seemingly more professionals dedicating themselves to careers in emergency psychiatry every day, there is hope that we will soon have all the personnel and resources necessary to tackle these enormous challenges and start moving the unfortunate statistics in a more positive direction. In that spirit, it is gratifying that Psychiatric Times has devoted a Special Report to emergency psychiatry.

Dr Zeller is vice president of acute psychiatry at the physician partnership Vituity and assistant clinical professor of psychiatry at the University of California, Riverside School of Medicine. He is an editorial board member of Psychiatric Times.

References

1. Khullar D. Reinventing the E.R. for America’s mental-health crisis. New Yorker. July 12, 2023. Accessed August 15, 2023. https://www.newyorker.com/science/annals-of-medicine/reinventing-the-er-for-americas-mental- health-crisis

2. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results From the 2021 National Survey on Drug Use and Health. US Department of Health & Human Services, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2022. HHS publication PEP22-07-01-005. NSDUH series H-57. December 2022. Accessed August 15, 2023. https://www.samhsa.gov/data/sites/default/files/reports/rpt39443/2021NSDUHFFRRev010323.pdf

3. Singh K. US suicide deaths reached record high in 2022, CDC data shows. Reuters. August 10, 2023. Accessed August 15, 2023. https://www.reuters.com/world/us/us-suicide-deaths-reached-record-high-2022-cdc-data-shows-2023-08-11/

4. Saidinejad M, Duffy S, Wallin D, et al; American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American College of Emergency Physicians Pediatric Emergency Medicine Committee; Emergency Nurses Association Pediatric Committee. The management of children and youth with pediatric mental and behavioral health emergencies. Pediatrics. 2023;e2023063255.

5. Fact sheet: Biden-Harris administration announces new actions to tackle nation’s mental health crisis. The White House. May 18, 2023. Accessed August 14, 2023. https://www.whitehouse.gov/briefing-room/statements-releases/2023/05/18/fact-sheet-biden-harris-administration-announces-new-actions-to-tackle-nations-mental-health-crisis/