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Psychiatric Emergency & Crisis Services APA Task Force on Psychiatric Emergency Services Michael H. Allen, M.D., Chair Peter Forster, M.D. Joseph Zealberg, M.D. Glenn Currier, M.D. Report and Recommendations Regarding Psychiatric Emergency and Crisis Services A Review and Model Program Descriptions August 2002 THE HISTORY OF THIS TASK FORCE AND A SUMMARY OF AVAILABLE DATA .........................4 Introduction ................................................................................................................................ 4 Toward "Organizationally Unique Treatment Facilities"........................................................... 4 Lack of Standards .................................................................................................................... 5 Funding Problems .................................................................................................................... 5 THE HISTORY OF THE TASK FORCE .....................................................................................7 A REVIEW OF THE LITERATURE ...........................................................................................8 Psychiatric Emergency Defined ............................................................................................... 8 Conceptualizing Emergency Services...................................................................................... 8 Hospital Based Services .......................................................................................................... 9 Consultation Liaison ............................................................................................................. 9 Specialized Psychiatric Emergency Department.................................................................. 9 Space.................................................................................................................................... 9 Core Staff............................................................................................................................ 10 Support Services ................................................................................................................ 11 Extended Observation or Crisis Hospitalization..................................................................... 11 Variants............................................................................................................................... 11 Structure ............................................................................................................................. 12 Special Situations ............................................................................................................... 12 Advantages and Outcomes Data........................................................................................ 13 Community Services .............................................................................................................. 13 Crisis Residential Services and Respite Care.................................................................... 13 Mobile Response ................................................................................................................ 15 Ambulatory Crisis Care....................................................................................................... 18 Telemedicine ...................................................................................................................... 18 PROPOSED CATEGORIZATION AND MODEL PROGRAM DESCRIPTIONS ................................19 Introduction .............................................................................................................................. 19 Types of Crisis and Emergency Psychiatric Services ......................................................... 19 Psychiatric Emergency Services in Medical Emergency Settings ..................................... 20 Definition................................................................................................................................. 20 Level of Care .......................................................................................................................... 21 Description.............................................................................................................................. 21 Assessments ...................................................................................................................... 21 Treatment Planning ............................................................................................................ 23 Medication Use and Safety................................................................................................. 23 Seclusion and Restraint...................................................................................................... 24 Aftercare ............................................................................................................................. 24 Space and Equipment ........................................................................................................ 25 Staffing................................................................................................................................ 25 Medical Records ................................................................................................................. 26 Quality Improvement........................................................................................................... 26 Leadership .......................................................................................................................... 26 Ethics and Patient’s Rights................................................................................................. 26 Psychiatric Emergency Service Facility ............................................................................... 27 Definition............................................................................................................................. 27 Level of Care ...................................................................................................................... 28 Description.......................................................................................................................... 28 Assessments ...................................................................................................................... 28 Treatment and Treatment Planning.................................................................................... 31 Medication Use and Safety................................................................................................. 32 Seclusion and Restraint...................................................................................................... 32 Aftercare ............................................................................................................................. 33 Space and Equipment ........................................................................................................ 34 1 Staffing................................................................................................................................ 35 Medical Records ................................................................................................................. 37 Quality Improvement........................................................................................................... 37 Leadership .......................................................................................................................... 38 Disaster Plan ...................................................................................................................... 38 Ethics and Patient’s Rights................................................................................................. 39 23 Hour Observation and 72 Hour Extended Observation .................................................. 40 Psychiatric Urgent Care Facility............................................................................................. 41 Definition................................................................................................................................. 41 Level of Care .......................................................................................................................... 42 Description.............................................................................................................................. 42 Assessments .......................................................................................................................... 42 Treatment and Treatment Planning.................................................................................... 45 Medication Use and Safety................................................................................................. 45 Seclusion and Restraint...................................................................................................... 46 Aftercare ............................................................................................................................. 46 Space and Equipment ........................................................................................................ 47 Staffing................................................................................................................................ 48 Medical Records ................................................................................................................
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