A Special Kind of ER
A 2019 report follows hospitals creating dedicated psychiatric emergency units where patients receive rapid treatment, compassionate support and a calmer path toward recovery instead of boarding for days in a conventional ER.
Original reporting by Anna Gorman, Kaiser Health News • March 25, 2019
Why create a separate emergency setting for mental health?
Traditional emergency rooms often lack the time, staff and environment needed to treat a psychiatric crisis. Specialized units bring together nurses, social workers and psychiatrists to stabilize patients, begin treatment and connect them with longer-term resources—often within 24 hours.
With mental health beds in short supply, emergency departments have become both the first and last resort for many people in psychiatric crisis. The reporting describes patients sedated or restrained on gurneys for days while they wait for placement, even as noise and chaos worsen their symptoms.
Dedicated psychiatric emergency units offer another path. In calmer, living room-like settings, patients can rest, receive medication, speak with clinicians and recover long enough for the team to determine whether they can return home or need inpatient care.
Psychiatric emergency care by the numbers
>50% rise
In ER visits involving psychosis, bipolar disorder, depression or anxiety from 2006 to 2013.
1 in 8
Emergency-department visits stemmed from mental illness or substance-use disorders.
~100 units
Specialized psychiatric emergency programs were operating nationwide when the story was published in 2019.
~75%
Of patients in the Alameda model could be discharged to the community rather than inpatient care.
Traditional emergency rooms can make a crisis harder
For a person living with schizophrenia, bipolar disorder, severe depression or another acute condition, a crowded medical ER can be a difficult place to begin recovery. Bright lights, noise, confinement and uncertainty may intensify distress while treatment is delayed.
Long psychiatric stays also consume scarce emergency beds and generate high costs for hospitals, insurers, taxpayers and families—often without providing the specialized care the patient needs.
1. Treat and release when it is safe
Psychiatric emergency units operate much like medical ERs: the goal is to address the immediate emergency, stabilize the patient and connect that person to the appropriate next level of care.
Patients who improve can return to the community with a plan. Those who require more intensive treatment are admitted or transferred to an inpatient psychiatric facility.
2. Replace isolation with an open, supportive environment
The unit at Providence Little Company of Mary Medical Center San Pedro was designed to feel more like a home than a hospital. Patients rested in recliners with blankets, ate at a shared kitchen table and could move around the open unit.
Private rooms along the perimeter provided space to meet with psychiatrists and social workers, while the open layout helped staff notice agitation early and intervene before a situation escalated.
3. Give clinicians time to listen and intervene
Rachel Diamond, who had experienced repeated ER visits related to depression and anxiety, spent about 26 hours at the San Pedro behavioral-health center. During that stay, she rested, received medication and met with nurses, a social worker and a psychiatrist.
Her experience illustrates the model’s central difference: staff had the time and setting to talk with her and help her through the crisis rather than simply medicate, isolate and wait.
4. Match each patient with the right next step
Not every psychiatric emergency resolves during a short stay. The report also follows Chantelle Unique, a young woman with bipolar disorder and schizophrenia who arrived after a severe psychotic episode and needed transfer for more intensive treatment.
Even when discharge home is not appropriate, the specialized unit can provide safety, food, medication and compassionate care while staff locate a suitable inpatient placement.
The San Pedro unit serves ERs across Los Angeles County
Providence opened its outpatient behavioral-health center in 2017 in a building near the hospital’s traditional emergency department. It accepts patients from emergency rooms across Los Angeles County after medical stabilization, including some people placed on involuntary holds.
By early 2019, the program had already treated about 400 patients that year. Staff reported that violence and physical restraint were rare in the calmer, more observable environment.
The Alameda model demonstrated a return on investment
Scott Zeller, MD, pioneered the approach at John George Psychiatric Hospital in Alameda County, transforming a traditional ward into a supportive, living room-like setting. Research found that the model dramatically reduced time spent boarding in medical emergency rooms.
About three-quarters of patients could be discharged to the community rather than admitted, relieving pressure on scarce inpatient psychiatric beds and reducing the cost of prolonged emergency care.
Billings Clinic reduced psychiatric waiting time
Billings Clinic in Montana opened a psychiatric stabilization unit across the street from its conventional ER. After opening, average wait times for psychiatric patients fell from roughly 10 hours to four, and fewer patients required inpatient admission.
The program focused on the emergency-care goal of stopping immediate deterioration, stabilizing the patient and arranging the right ongoing treatment—not attempting to resolve a lifelong mental illness during a single visit.
The model can adapt to different hospitals and communities
Specialized psychiatric emergency units differ in whom they accept, how they are staffed and which services they provide. Some operate next to a medical ER; others are part of larger psychiatric facilities.
The shared approach is consistent: evaluate medically, transfer quickly into a lower-stimulation setting, begin psychiatric treatment, support recovery and avoid inpatient hospitalization when a safe community plan is possible.
What health systems can learn from these psychiatric ERs
- Design for recovery: Use comfortable, observable spaces that reduce noise, isolation and confinement.
- Bring specialists to the crisis: Staff units with psychiatric clinicians, nurses and social workers.
- Intervene early: Medication, rest and conversation should begin instead of waiting for placement.
- Reserve inpatient beds: Admit only patients who still require intensive care after stabilization.
- Plan beyond the visit: Connect every patient with community resources or an appropriate transfer to reduce return crises.
Article Highlights
- Dedicated psychiatric ERs aim to stabilize and release appropriate patients within 24 hours.
- Providence San Pedro created an open, home-like unit serving ERs across Los Angeles County.
- The Alameda model discharged about three-quarters of patients to the community.
- Billings Clinic reduced psychiatric wait times from about 10 hours to four.
Original Reporting
Read Anna Gorman’s complete reporting and patient stories as published by the Post Bulletin.