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 ................................................................................................................