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Discussion

Psych in the ER

I know you guys are probably getting tired of psych posts in the ER category but it's a topic I know virtually nothing about so I want to know what the ER nurses think! (I am not a nurse.) Working nights in the ER, we get the occasional depressed, sometimes suicidal, but voluntary patient who decides they need help. We have protocol for their safety on the unit, assistance for them to store their belongings etc. My question is: Is it really fair to them as a patient who took the steps to get some help if we have the mental health evaluator talking to them at 0300 in the morning? I mean seriously, whether someone is clinically depressed or not all problems seem worse at night. I know the case can be made for getting them out quicker to free up the bed but is that fair to their need as a patient? How do you handle this in your ER? Do you have your own in-house mental health unit or do you send your patients to a local facility?

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    I think prompt attention to their psych help is needed. They should not have to wait until 8am - chances are they can't sleep anyway. So yes, getting them help ASAP is indeed good. I can't see why we should wait?

    I would be outraged to hear that voluntary patients had to wait to be seen and to speak to someone. This is something I would try and reduce!

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    In our hospital, we have a psych triage nurse to assess the pt and a telepsych ("doc on wheels") to see the pt at whatever time of day. That way, they quickly get into our in-house mental health unit or another facility. It's not that we need to free up the ED (which really is the case tbh) but because the mental health staff may be better equipped with the pt's needs.

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    • Author

    Excellent point and our patients do get seen quickly for whatever help we can provide. I am more referring to a full assessment with questions such as, "Why do you think these feelings are happening?" and "Do you find yourself crying often?", and so forth. If the patient felt that such detailed questions could be more accurately approached in the day, would you accommodate that request?

    PS. I see what you mean about the patient being unable to sleep; the reason I worded my question that was is because the patient I had just seen had a chief symptom of sleeping constantly and arousing only to physical stimulus. So like we always tell the patients, each case is different :)

    I think prompt attention to their psych help is needed. They should not have to wait until 8am - chances are they can't sleep anyway. So yes, getting them help ASAP is indeed good. I can't see why we should wait?

    I would be outraged to hear that voluntary patients had to wait to be seen and to speak to someone. This is something I would try and reduce!

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    • Author
    In our hospital, we have a psych triage nurse to assess the pt and a telepsych ("doc on wheels") to see the pt at whatever time of day. That way, they quickly get into our in-house mental health unit or another facility. It's not that we need to free up the ED (which really is the case tbh) but because the mental health staff may be better equipped with the pt's needs.

    Wow I wish my ER would do this!! It takes hours for us to get a psych assessor to our unit and we have held patients for 24 hours before for this reason.

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    • Experts

    The individual came to the ED seeking help. How is it "fair" to intentionally delay providing the help s/he is seeking? Why would it be reasonable or safe to just warehouse them until the morning? To me, that's not any different than saying someone who comes in during the night with a fever or chest pain should just be held until morning because they might feel better in the morning.

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    The patient is seeking emergency care, and has a right to emergency care.

    Questions such those you give as examples are part of trained psychiatric professionals' evaluation of the patient and used to determine if the patient has sufficient insight to be safely discharged to home with a plan for followup outpatient care, or requires inpatient admission.

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    The problem in our ER isn't the psych assessment as we have clinicians on site. The problem is that there are often no psych beds available and we have to hold people who have been accepted for admission. Our psych bubble isn't an appropriate place to hold people and they are sometimes there for days waiting for placement. So sad.

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