Models of Emergency Psychiatric Services That Work (Integrating Psychiatry and Primary Care)

Introduction: Models of Psychiatric Emergency Services That Work
Contents
Part I: Models of Emergency Psychiatry Care
	1: Models of Emergency Psychiatric Care
		1.1	 Introduction
		1.2	 Hospital-Based PES
		1.3	 Regional Dedicated Emergency Psychiatric Facility
		1.4	 Community-Based PES
		1.5	 Systems Integration and Crisis Prevention
		1.6	 Comprehensive Psychiatric Emergency Program
		1.7	 Summary
		References
	2: Business as Usual: Emergency Rooms with No Psychiatric Coverage at All
		2.1	 Introduction
		2.2	 Limitations and Capabilities of This System
		2.3	 Personnel and Staffing Needed
		2.4	 Patient and Staff Safety Concerns
		2.5	 Collaboration Needed
		2.6	 Expertise Needed
		2.7	 Resources Needed
		2.8	 Consideration of Coordination of Care
		2.9	 Interaction with Probate Courts and Criminal Justice System
		2.10	 Security Needed
		2.11	 Special Considerations
		2.12	 Summary
		References
	3: Psychiatric Consultation to the Emergency Department and Co-Management Model
		3.1	 Introduction
		3.2	 Liabilities and Capabilities of the System
		3.3	 Limitations of the System
		3.4	 Personnel and Staffing Needed
		3.5	 Patient and Staff Safety Concerns
		3.6	 Collaboration Needed
		3.7	 Expertise Needed
		3.8	 Considerations of Coordination of Care
		3.9	 Interactions with Probate Courts and the Criminal Justice System
		3.10	 Security Needed
		3.11	 Special Considerations
		3.12	 Summary
		References
	4: Adjacent Psychiatric Emergency Services to the Main Emergency Room
		4.1	 Introduction
		4.2	 Liabilities and Capabilities of the System
		4.3	 Limitations of the System
		4.4	 Personnel and Staffing Needed
		4.5	 Patient and Staff Safety Concerns
		4.6	 Collaboration Needed
		4.7	 Expertise Needed
		4.8	 Resources Needed
		4.9	 Considerations of Coordination of Care
		4.10	 Interactions with Probate Courts and Criminal Justice System
		4.11	 Security Needed
		4.12	 Summary
		References
	5: Crisis Stabilization Services
		5.1	 Introduction
		5.2	 Liabilities and Capabilities of This System
		5.3	 Limitations of This System
		5.4	 Personnel and Staffing Needed
		5.5	 Patient and Staff Safety Concerns
		5.6	 Collaboration Needed
		5.7	 Expertise Needed
		5.8	 Resources Needed
		5.9	 Considerations of Coordination of Care
		5.10	 Interactions with Probate Courts and Criminal Justice System
		5.11	 Security Needed
		5.12	 Summary
		References
	6: Crisis Intervention Team
		6.1	 Introduction
		6.2	 Liabilities and Capabilities of the System
		6.3	 Limitations of the System
		6.4	 Personnel, Staffing, and Expertise Needed
		6.5	 Patient and Staff Safety Concerns
		6.6	 Collaboration and Resources Needed
		6.7	 Considerations of Coordination of Care
		6.8	 Interactions with Probate Courts and the Criminal Justice System
		6.9	 Special Considerations
		6.10	 Summary
		References
	7: Alternative Models of Emergency Psychiatric Care: Regional Emergency Psychiatric Facilities, Freestanding Emergency Departments, and Urgent Care Centers
		7.1	 Introduction
		7.2	 Liabilities and Capabilities of These Systems
		7.3	 Limitations of These Systems
		7.4	 Personnel and Staffing Needed
		7.5	 Patient and Staff Safety Concerns
		7.6	 Collaboration Needed
		7.7	 Expertise Needed
		7.8	 Resources Needed
		7.9	 Considerations of Coordination of Care
		7.10	 Interactions with Probate and the Criminal Justice System
		7.11	 Security Needed
		7.12	 Special Considerations
		7.13	 Summary
		References
	8: Transition Clinic: Reducing Recidivism
		8.1	 Introduction
		8.2	 Transitional Clinic Models
		8.3	 Liabilities and Capabilities of This System
		8.4	 Limitations of the System
		8.5	 Personnel and Staffing Needed
		8.6	 Patient and Staff Safety Concerns
		8.7	 Collaboration Needed
		8.8	 Expertise Needed
		8.9	 Resources Needed
		8.10	 Considerations of Coordination of Care
		8.11	 Interactions with Probate Courts and the Criminal Justice System
		8.12	 Special Considerations
		8.13	 Summary
		References
Part II: So What Do I need?
	9: What Physical Facilities Are Needed: The Question of Medical Clearance in Emergency Psychiatric Settings
		9.1	 Introduction
		9.2	 Medical Clearance
		9.3	 History and Physical Examination
		9.4	 Screening Tests
		9.5	 Laboratory Testing
		9.6	 Summary
		References
	10: Administration in Emergency Psychiatry
		10.1	 Introduction
		10.2	 Determine Scope of Practice
		10.3	 Develop Clinical Policies
		10.4	 Cultivate Relationships with Stakeholders
		10.5	 Collaborate with Community Partners
		10.6	 Conduct Quality Improvement
		10.7	 Manage Personnel
		10.8	 Satisfy Regulatory Requirements
		10.9	 Educate the Team
		10.10	 Generate Knowledge
		10.11	 Manage with Financial Acumen
		10.12	 Summary: Bringing It All Together
		References
	11: Nursing Staff in Psychiatric Emergency Services
		11.1	 Introduction
		11.2	 Safety
		11.3	 Teamwork
		11.4	 Quality
		11.5	 Summary
		References
	12: Safety and Security in Emergency Psychiatry
		12.1	 Introduction
		12.2	 Safety as a Common Challenge
		12.3	 Leadership Issues
		12.4	 Staff Issues
		12.5	 Resident Issues
		12.6	 Nursing Issues
		12.7	 Patient Issues
		12.8	 Violence Assessment
		12.9	 Communication
		12.10	 Physical Environment
		12.11	 Summary
		References
	13: Supervision of Ancillary Personnel
		13.1	 Introduction
		13.2	 The Rationale for Psychiatric Emergency Clinicians (PECs)
		13.3	 Essential Skills for PECs
		13.4	 Clinical Example
		13.5	 Psychiatric Trainees (Residents/Students) as PECs
		13.6	 Summary
		References
	14: Financial Considerations for Emergency Psychiatry Services
		14.1	 Introduction
		14.2	 Financing Psychiatric Emergency Service: The Intersection of Psychiatry and the Emergency Room
		14.3	 The Hidden Costs of Not Having Psychiatric Emergency Services
		14.4	 The Direct Costs of Running a Psychiatric Emergency Service
		14.5	 Selecting an Appropriate Model of Psychiatric Emergency Services
		14.6	 Outside Funding and Community-Wide Collaboration
		14.7	 Summary
		References
	15: Telepsychiatry
		15.1	 Introduction
		15.2	 Benefits of Telepsychiatry
		15.3	 Technical Considerations
		15.4	 Legal Considerations
		15.5	 Cost Considerations
		15.6	 Emergency Considerations
		15.7	 Summary
		References
	16: Identifying and Understanding Legal Aspects of Emergency Psychiatry Unique to Different Jurisdictions
		16.1	 Introduction
		16.2	 Considerations on Risk
		16.3	 Understanding the Clinical Context
		16.4	 Getting Good Advice
		16.5	 Critical Questions
		16.6	 Summary
		References
	17: Special Populations in Psychiatric Emergency Services: Children and Adolescents
		17.1	 Introduction
		17.2	 The Challenges of Pediatric Psychiatric Patients in the ED
		17.3	 Making Emergency Services Work for Children in Crisis
		17.4	 Staffing the ED to Serve Youth in Psychiatric Crisis
		17.5	 Caring for Special Populations in the ED
		17.6	 Summary
		References
	18: Special Populations in Psychiatric Emergency Services: The Geriatric Patient
		18.1	 Introduction
		18.2	 The Challenges of Older Patients
		18.3	 Aggression and Agitation
		18.4	 Depression
		18.5	 Suicidality
		18.6	 Elder Abuse and Neglect
		18.7	 Making Emergency Services Work for Geriatric Individuals in Crisis
		18.8	 Training in Geriatric Psychiatry/Medicine
		18.9	 Summary
		References
	19: Special Populations in Psychiatric Emergency Care: Forensic Patients
		19.1	 Introduction
		19.2	 Definitions of Confinement Facilities and Forensic Patients
		19.3	 Psychiatric Decompensation in Forensic Patients
		19.4	 Recreational Abuse of Psychotropic Medications
		19.5	 Forensic Patients, Suicide Risk, and Violence Risk
		19.6	 Cooperating with Law Enforcement
		19.7	 Summary
		References
Part III: Selected International Models of Psychiatric Emergency Care
	20: International Models of Psychiatric Emergency Care: Canada
		20.1	 Introduction
		20.2	 Emergency Psychiatry Service Structure
		20.3	 Emergency Psychiatry Service Systems Flow
		20.4	 Personnel and Staffing: The Psychiatric Emergency Services Team
		20.5	 Considerations of Coordination of Care
		20.6	 Health Care Funding and Resources
		20.7	 Mental Health Legislation
		20.8	 Education
		20.9	 Quality Initiatives and Quality Assurance
		20.10	 Summary
		References
	21: International Models of Psychiatric Emergency Care: United Kingdom
		21.1	 Introduction
		21.2	 Emergency Psychiatry Service Structure
		21.3	 Emergency Psychiatry Service Systems Flow
		21.4	 Patient and Staff Safety Concerns
		21.5	 Personnel and Staffing: The Psychiatric Emergency Services Team
		21.6	 Considerations of Coordination of Care
		21.7	 Health Care Funding and Resources
		21.8	 Mental Health Legislation
		21.9	 Education
		21.10	 Quality Initiatives and Quality Assurance
		21.11	 Summary
		References
	22: International Models of Emergency Psychiatric Care: The Republic of Serbia
		22.1	 Introduction
		22.2	 Emergency Psychiatry Service Structure
		22.3	 Emergency Psychiatry Service Systems Flow
		22.4	 Patient and Staff Safety Concerns
		22.5	 Personnel and Staffing: The Psychiatric Emergency Services Team
		22.6	 Considerations of Coordination of Care
		22.7	 Healthcare Funding and Resources
		22.8	 Mental Health Legislation
		22.9	 Education
		22.10	 Quality Initiatives and Quality Assurance
		22.11	 Summary
		References
	23: International Models of Psychiatric Emergency Care: The State of Qatar
		23.1	 Introduction
		23.2	 Emergency Psychiatry Service Structure
		23.3	 Emergency Psychiatry Service Systems Flow
		23.4	 Patient and Staff Safety Concerns
		23.5	 Personnel and Staffing: The Psychiatric Emergency Services Team
		23.6	 Considerations of Coordination of Care
		23.7	 Healthcare Funding and Resources
		23.8	 Mental Health Legislation
		23.9	 Education
		23.10	 Quality Initiatives and Quality Assurance
		23.11	 Summary
		References
	24: International Models of Emergency Psychiatric Care: Pakistan
		24.1	 Country Demographics and Information
		24.2	 Emergency Psychiatry Service Structure
		24.3	 Emergency Psychiatry Service Systems Flow
		24.4	 Patient and Staff Safety Concerns
		24.5	 Personnel and Staffing: The Psychiatric Emergency Services Team
		24.6	 Considerations for Coordination of Care
		24.7	 Health Care Funding and Resources
		24.8	 Mental Health Legislation
		24.9	 Education
		24.10	 Quality Initiatives and Quality Assurance
		24.11	 Summary
		References