Recommendations to Address Emergency Psychiatric Staff Shortages

What is it about?

The number of psychiatric patients presenting to emergency departments continues to rise. It is estimated that those numbers will rise further because of the COVID-19 crisis. Many of these patients presenting in psychiatric distress are seen, evaluated, and discharged from emergency departments without any involvement of a mental health professional. This continues to occur even with the involvement of advanced practice psychiatric nurse practitioners and physician assistants. The lack of psychiatric physicians, as well as the additional above-mentioned mental health providers, has led to a scenario where critical staff shortages now mandates an imminent examination of sustainable, safe alternatives. To increase the workforce, the AAEP has formulated eight specific training recommendations that can be utilized for preparing individuals for a role as a psychiatric emergency clinician. These additional members of the treatment team would not be utilized to replace medical decision making or physician scope, but to supplement their efforts and provide aid to emergency departments lacking any physical presence of a mental health professional. Utilizing these clinicians requires formal skills and training. This paper details recommendations for education, oversight, and supervision of these clinicians so that patients in crisis will be evaluated by a staff member trained in the necessary elements of emergency psychiatry.

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Why is it important?

The number of psychiatric patients presenting to emergency departments is increasing, and there are not enough psychiatrists, NPs or PAs to see all these patients. We need to expand the workforce, and this paper gives suggestions as to how to do it. The goal is not to replace the psychiatrist, but to supplement the them and expand the workforce.