Behavioral Health

Every day, people with behavioral health issues seek help, but have nowhere to turn except their local emergency department. These patients not only utilize more resources than other patients, they are also forced to wait, sometimes for days, until a bed in an inpatient facility becomes available.

“Behavioral health” encompasses various conditions characterized by impairment of an individual's normal cognitive, emotional, or behavioral functioning. Impairments include those caused by substance use disorders and/or behavioral health conditions resulting from social, psychological, biochemical, genetic, or other factors such as infection or head trauma (Source: ENA Topic Brief: Care of Behavioral Health Patients). 

The therapeutic management of behavioral health patients in the emergency department presents some unique and complex issues. There is not a defined set of diagnostic tests that can be ordered to determine the course of their care, and many facilities do not have the on-site services necessary to provide appropriate care. The following resources are provided to assist emergency nurses in improving care for this patient population.

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Resources

Emergency Care Psychiatric Clinical Framework
A consistent practice model for competent and accountable emergency psychiatric clinical care regardless of facility or time of day.

Clinical Practice Guideline Synopsis
Reviews the effectiveness of risk assessment tools and predictors in screening for self-harm or suicidal ideation during initial assessment of patients across the life span in the emergency care setting.

Topic Brief: Care of Behavioral Health Patients in the Emergency Department
Summarizes Care of the Psychiatric Patient in the Emergency Department

White Paper:  Care of the Psychiatric Patient in the Emergency Department
Foundational publication that identified best practices and gaps in the care of the behavioral health patient in the ED.

Toolkits

Workplace Violence Toolkit 
ENA’s Workplace Violence Toolkit offers practical solutions to violence in emergency departments. The toolkit provides resources to address this issue at all levels of the institution: hospital administration, division or department management, educators, and staff. The templates and tools provide an easy step-by-step procedure for customizing a violence prevention plan that will meet the needs of your department.

Education

Behavioral issues are covered in TNCC, ENPC, and GENE. The following online courses focus specifically on behavioral health.

Free CE: Wounded Warriors: PTSD & Suicide in Returning Veterans
Explains the psychological forces of warfare which can lead to PTSD and suicidal intent in veterans, symptoms of PTSD and treatment options.

Handling Psychiatric Emergencies

Fifteen lessons that cover concepts from triage to suicide assessment to substance abuse with custom, live-action videos that explore common psychiatric scenarios and interventions, and features with useful information and tips that may be important to remember, such as Consult the Expert, Legal & Ethical Considerations, and Safety Alerts

Legislation

Mental health reform and workplace violence are two of ENA’s key legislative initiatives. We must start to fix our broken mental health system by focusing programs and resources on the psychiatric care for patients and families most in need of services. We must increase the availability of inpatient psychiatric beds, expand the mental health workforce, and integrate between physical and mental health care providers. Strong legislation to protect emergency nurses helps to reinforce that violence is not part of the job.

Emergency Nurses Association Members Descend on Capitol Hill to Fight for Better Emergency Care
05/1/17

ENA Joins Mental Health Liaison Group in Sending Letter to Congressional Leadership in Support of Mental Health and Substance Abuse Care
03/2/17

ENA Joins Coalition Letter in Support of the Mental Health and Substance Abuse Treatment Accessibility Act of 2017

2/28/17

ENA Communicates Health Care Policy Principles to Congressional Leadership
01/10/17

ENA Applauds Senate Passage of Comprehensive Mental Health Reform and Opioid Treatment Funding Legislation
12/7/2016

ENA Praises House Passage of Comprehensive Mental Health Reform
11/30/2016

Tips and Tools

 

Research & Articles

‚ÄčU.S. emergency nurses’ perceptions of challenges and facilitators in the management of behavioral health patients in the emergency department: A mixed-methods study
Australasian Emergency Nursing Journal, April 2015
This study's purpose is to describe U.S. emergency nurses' estimates of lengths of stay for behavioral health patients, explore factors affecting length of stay, and assess nurses' perceptions of their skills, beliefs/attitudes, and confidence in caring for this population.

Behavioral Health Emergencies  
Journal of Emergency Nursing, January 2016
The emergency department is an access point for many children in acute mental health crisis. A complete medical examination needs to be performed for children arriving with behavioral health emergencies. A psychiatric evaluation should be conducted after a medical cause for their behavior has been eliminated…

Behavioral Health Patients in the Emergency Department
Journal of Emergency Nursing, March 2014
As nurses, we must examine our own beliefs, attitudes, and actions when it comes to providing care for patients with behavioral health issues. It seems clear that for the foreseeable future, behavioral health patients will be a large component of the emergency patient population…

Medical Evaluation of the Behavioral Health Emergency Patient
Journal of Emergency Nursing, January 2016
J. Doe, a 64-year-old woman, was brought in by police for a psychiatric evaluation after she was found walking toward the middle of a lake at a local park. When questioned, she stated, “They say I have to save my son; my husband is going to kill him.” Upon further questioning, the patient said she was told to come to the park to meet her son and she could not find him…

Find more Journal of Emergency Nursing articles

Other Resources

American Psychiatric Nurses Association (APNA)

Centers for Disease Control & Prevention (CDC): Mental Health

National Alliance on Mental Illness (NAMI)

National Institutes of Mental Health (NIMH)

U.S. Department of Health & Human Services Substance Abuse and Mental Health Services Administrationn

Working to promote safe practice and safe care.