2023 14th Annual NUBE Conference

As nationwide recognition grows of the post-pandemic surge in serious behavioral health issues, there has been an unprecedented level of attention and support for creating acute behavioral healthcare intervention options. 988 is now well established and handling tens of millions of calls per year. States, counties and communities are developing call centers, mobile crisis teams, peer-run facilities and crisis receiving centers. Simultaneously, many hospitals have been initiating emergency psychiatry units, telepsychiatry, improved staff training, and other adaptations, to improve the care for behavioral emergencies, which now number one in every seven patients in emergency departments in the USA -- as well as working to eliminate the long-standing problem of psychiatric patients boarding for long hours or days, untreated, in emergency departments, awaiting admission to an elusive behavioral health inpatient bed. Yet with all this promising movement, a surprising dichotomy has emerged. Community-focused crisis planning often completely ignores hospital-based programs, or even refers to hospitals solely as places individuals in crisis should go only when medical clearance and inpatient psychiatric hospitalization are warranted. While Emergency Psychiatry clinicians are investigating new treatment modalities or novel agents for calming agitation, the Community Crisis professionals may see their roles very differently – as one recently said, “Crisis Stabilization to me consists of a cup of tea and a sympathetic ear”. Meanwhile, “Crisis Stabilization” as a term itself can have wildly different meanings depending on where you are; in some parts of the country, crisis stabilization is a 23-hour observation, in others it’s a weeks-long subacute stay, while in still other places crisis stabilization is defined as a six-month residential substance abuse program. Not only has this confusing variation been noticed by behavioral health professionals, but has now even become a subject of debate among healthcare architects.Is it finally time for standardized, clearly defined nomenclature for all these? And should “crisis” and “emergency psychiatry” even be categorized together? As the three main models of hospital based ‘crisis’ programs – PES, CPEP, EmPATH – all have ‘emergency psychiatry’ as part of their names, but not ‘crisis’, should we think of Emergency Psychiatry and Crisis Care as two separate, though related, entities? Is an Emergency and a Crisis two different things, or different levels of acuity of the same thing? Or is there enough in common that Emergency Psychiatry and Crisis Care should still be considered part of the same spectrum or continuum?The presenter will share these concepts and propose a new set of definitions and hierarchies which could, if implemented, might better standardize this arena in the future. It is expected that these ideas may be controversial to some in the audience, so questions and a robust conversation with the audience will be encouraged.

Learning Objectives:

1. Identify the most prominent developments in Emergency Psychiatry and Crisis Care in the past five years.
2. Describe the ways that Emergency Psychiatry and Crisis Care can be construed as part of the same spectrum or as completely different concepts. 
3. Recite a modern set of definitions and hierarchy that might establish a better understanding of both Emergency Psychiatry and Crisis Care.