Psychiatric Emergencies in Nonpsychiatric Settings: Perception Precludes Preparedness

Abstract

Background: The implementation of emergency codes has become standard practice in hospitals to provide system-wide preparedness for the early detection and prevention of crises. Psychiatric emergencies in medical/surgical locations, however, are not typically regarded as distinct entities from general security threats. The "security-first" paradigm is a nonclinical intervention that focuses on behavioral containment rather than on the treatment of underlying psychopathology.

Objective: This article provides the perspective that countless opportunities to medically intervene upon mental health emergencies are being overlooked due to a national misconception of these entities as security-based functions. A secondary consequence of this misperception is that hospital systems often fail to prioritize an infrastructure onto which clinically-informed emergency response protocols similar to other medical emergency codes may be dependably mounted in the event of accurately detecting psychiatric emergencies. Numerous adverse clinical, workplace safety, and financial outcomes ensue. Using a behavioral emergency response team as a collaborative care model in medical/surgical locations is a promising alternative.

Conclusions: Behavioral emergency response teams re-establish patient care within the intervention without omitting security containment. They help rapidly address acute comorbid psychiatric needs without demanding additional psychiatric resources by functioning as trained surrogates of consult-liaison psychiatry as they provide direct clinical oversight into primary teams who would otherwise be unsupported in navigating clinical scenarios extending beyond their typical range of expertise. An analysis using the "Swiss cheese" model of human error trapping offers a comprehensive illustration of how behavioral emergency response teams add multilayered perceptual and mechanistic advantages to barriers commonly encountered when psychiatric emergencies arise in nonpsychiatric settings.

Keywords: adverse outcomes; collaborative care; psychiatric emergencies; quality improvement; rapid response; workplace violence.