Mental health pt in ER...


I need opinions from ER staff about caring for mental health patients in the ER. Is your facility equipped to handle these patients? If not, how do you handle them?

Specializes in Emergency Room.

We built a new ED last year, and had 4 rooms specifically built for our psych patients. These rooms have cameras in the corners (built in), all medical equipment is behind what we lovingly call a "garage door" that can be locked down, there is nothing on the walls, and no tv (drives me crazy because even a non-psych pt will go nutty on you after 4 hours in that room!). The rooms have keyed locks on the back door (that lead to the back hallway), and we have the ability to lock the front door as is an electronic keypad, and we also have two switches to turn off the outlets once someone is placed into seclusion. Additionally, we have the infamous chair (5 point restraint chair) that can be pulled in there if someone needs additional incentive to calm down.

There are a lot of restrictions on placing someone into seclusion. You have to havce someone at the door for an hour, then check on them q 15, etc etc. I have only used it once in the last 6 months, but it was worth its weight in gold!

I hope I answered your question. I definitely felt our old dept was not safe for psych patients, but this one definitely is. Additionally, all psych patients (I should say all "at risk" psych patients...SI, HI, delusional, hallucinating, manic, etc) are put in gown and belongings removed from room. Not as much of a deterrent to running in the summer, but now when it is 30 degrees outside, they think twice!

NicoleRN07, RN

133 Posts

Specializes in Med/Surge, ER. Has 7 years experience.

We just built a new ER, and 2 psych rooms were added. There is a large window (unbreakable, of course) for each room , and both are equipped with a camera. All medical equipment is hidden. There is no TV.

Trauma Columnist

traumaRUs, MSN, APRN

153 Articles; 21,232 Posts

Specializes in Nephrology, Cardiology, ER, ICU. Has 31 years experience.

Our ER also had a seclusion room: easily locked, TV behind plexiglass, camera behind plexi-glass. Nothing on the walls, cart had no oxygen tank, etc. Pretty secure.

Specializes in CT ,ICU,CCU,Tele,ED,Hospice. Has 36 years experience.

we don't have a seclusion room .we have a 4 bed open room we put our psych pts in .tv only .doesn't lock .we 4 pt restrain and sedate them as needed .if pts real bad will put him/her in a single room with sitter .sitter is in other room as well.i have worked 2 other places that had a seclusion room .

neneRN, BSN, RN

642 Posts

Specializes in Emergency, Trauma. Has 8 years experience.

We have a 4 bed psych room where 1-2 security guards sit in the room with the patients. No TV or supplies. Nursing station right across the hall. RN and tech care for the 4 pts.

TazziRN, RN

6,487 Posts

We are not equiped for psych pts at all. We do medical clearances and then transfer them up the road to a psych facility for mental health clearance. If a pt comes in without a relative/friend who can sit with them while they're with us, we place the pt in one of the three beds that can be seen from the nurses' station. If the pt is placed on a hold by law enforcement and they don't want to make the drive up to psych, we insist that they sit with the pt until we can get them transferred.

Specializes in Emergency Dept, ICU. Has 11 years experience.

We have 2 rooms for psych. They are 4 walls two doors. One door goes to nsg station the other door goes outside (for xfer to jail or mental health facility) (So we don't have to parade them down the hall and out the front doors).

They are both locked inside and out. Have to use a key to get in or out. Audio/Video monitoring, no TV. Call light button on the wall.

Specializes in ER, ICU, L&D, OR.

In ER all patients are mental at least untill they are drugged up, discharged,admitted, or transferred or dispositioned in any way possible.


248 Posts

Specializes in 6 years of ER fun, med/surg, blah, blah. Has 15 years experience.

3 weeks ago we opened a 10 bed ED psych unit, the EPU, (Hahahaha!), that has 3 locked door seclusion rooms & 7 bays with a lounger in each. After said patients are sober, come down from whatever they are on & just come in because they threatened to kill themselves, &/or someone else or need an RX refill or feel unsafe, they can wait there. We are trying to discourage those who treated the ED as a flop house, to sleep off their ETOH fun for several hours & make a loud, annoying nuisance of themselves before signing out AMA or with treatment info they won't follow up on. Our psych patients have increased by 40% over the past couple of years & instead of having them take over our medical rooms or hanging out in the hallways, we now have our EPU for these people to see psych staff & either be admitted or transferred or discharged with follow up info.

So far we have not started any group therapy, but it's mainly a holding area. It's quiet & out of the regular ED milieu, so they are not stirred up by all the drama that goes on on a usual day. So far, so good. But staff getting off the unit for a lunch break, forget it.


405 Posts

Specializes in LTC.

Great info and insight everyone. Thanks.

Specializes in Case Manager, Home Health.
I need opinions from ER staff about caring for mental health patients in the ER. Is your facility equipped to handle these patients?

Which ER pts AREN'T mental health pts? [sorry, couldn't help it...]

At our small community hospital we hold mental health pts for a county mental health worker eval and then transport to a facility that worker has found who will take the pt.

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