While We Wait: What’s Next — The EmPATH Way Forward
HEALTH AFFAIRS PODCAST While We Wait: What’s Next — The EmPATH Way Forward Health Affairs Pathways hosts Avni Kulkarni and Sania Ali speak with EmPATH creator Scott Zeller, MD, about how dedicated psychiatric emergency units could reimagine crisis treatment and move care beyond emergency-department boarding. Produced by Sania Ali and Avni Kulkarni, Health Affairs Pathways • April 20, 2022 What if a psychiatric emergency led directly to treatment instead of waiting? In the final episode of the “While We Wait” series, Kulkarni and Ali examine EmPATH—emergency psychiatric assessment, treatment and healing—as a practical alternative to prolonged mental-health boarding in conventional emergency departments. The episode closes a series devoted to the mental-health boarding crisis by shifting the focus from the problem to a possible solution. Featured guest Scott Zeller, MD, developed the EmPATH model and joined the hosts to discuss how hospitals can redesign the delivery of emergency psychiatric treatment. Rather than keeping a person in crisis in a medical ED while awaiting disposition, EmPATH creates a dedicated setting for rapid assessment, active treatment, observation and recovery-oriented care. The podcast episode at a glance 18 minutes Runtime of the final “While We Wait” episode. Episode 13 Its place in the Health Affairs Pathways podcast feed. 2 producers Sania Ali and Avni Kulkarni created and hosted the series. 1 expert guest Scott Zeller, MD, creator of the EmPATH model. The series begins with the boarding crisis “While We Wait” examines what happens when people experiencing mental-health emergencies reach hospitals that are not structured to provide immediate psychiatric treatment. Long waits can leave patients in emergency departments with little therapeutic progress. The final episode asks what comes next: how can systems replace stalled care with a pathway designed around stabilization and healing? 1. Make treatment the first response EmPATH changes the objective from simply evaluating and holding a patient to beginning psychiatric care promptly. Assessment, medication, therapeutic engagement and care planning can occur in the same dedicated environment. That shift treats the emergency as a clinical need requiring immediate intervention—not a placement problem to be resolved later. 2. Build a setting for psychiatric recovery A conventional medical ED is designed for speed, procedures and physical emergencies. Its noise, isolation and constant activity may work against the needs of someone in emotional or psychiatric distress. EmPATH units create a calmer, less coercive space where patients can remain visible to staff, move safely through the environment and participate in care. 3. Bring psychiatric expertise closer to arrival The model connects patients with clinicians who are prepared to evaluate and treat acute behavioral-health needs. Rapid access to psychiatric expertise can clarify the crisis, begin an appropriate care plan and reduce time spent waiting for the next decision. For hospitals, this requires clinical workflows that connect emergency medicine and behavioral health rather than leaving them in separate operational lanes. 4. Allow time for stabilization before disposition A crisis presentation does not always indicate a need for inpatient hospitalization. A dedicated observation period gives treatment time to work and clinicians time to reassess the patient’s needs in a supportive setting. The destination decision can then reflect the patient’s response to care, with discharge and community follow-up considered alongside inpatient admission. EmPATH reframes space and time as clinical tools The model’s innovation is not limited to a new room or unit name. It uses the physical environment and a longer therapeutic encounter to change what can happen during a psychiatric emergency. Space can reduce stimulation and support engagement; time can allow medication, conversation, rest and observation to produce a clearer path forward. The model offers an alternative to boarding Psychiatric boarding occurs when patients remain in emergency departments while waiting for an inpatient bed or another service. During that interval, treatment may be limited and the medical ED bed remains unavailable for other emergencies. EmPATH offers a separate care pathway where the waiting period becomes active psychiatric treatment rather than a pause between evaluation and placement. A patient-centered approach can reduce coercion Recovery-oriented care emphasizes dignity, collaboration and the least restrictive appropriate setting. EmPATH is designed to support those principles through open observation, visible staff and therapeutic engagement. For patients, the experience can feel less like containment and more like receiving care for a health emergency. Hospitals must redesign operations, not only space A dedicated environment works only when staffing, assessment, medication management, observation and discharge planning are aligned around rapid psychiatric care. Physical renovation without an operating model would leave the central problem unresolved. Implementation therefore requires collaboration among behavioral-health clinicians, emergency teams, hospital leaders and community providers. The EmPATH way forward Replace passive waiting: Begin assessment and treatment as soon as the patient enters the psychiatric pathway. Design for recovery: Use a calmer, supportive environment that matches behavioral-health needs. Observe before deciding: Give stabilization time to reveal the most appropriate next level of care. Connect the continuum: Coordinate the ED, psychiatric clinicians, inpatient services and community follow-up. Treat the model as system change: Pair the physical unit with new staffing, workflows and expectations. Episode Highlights The episode concludes Health Affairs’ “While We Wait” series on mental-health boarding. Hosts Avni Kulkarni and Sania Ali explore EmPATH with model creator Scott Zeller, MD. EmPATH centers emergency psychiatric care on assessment, treatment, healing and stabilization. The approach offers hospitals a path beyond prolonged boarding in conventional EDs. Original Podcast Listen to the complete Health Affairs Pathways episode produced by Sania Ali and Avni Kulkarni, featuring Scott Zeller, MD. Listen to the Episode
How 3 Hospitals Are Reimagining Behavioral Crisis Care
BEHAVIORAL CRISIS CARE How 3 Hospitals Are Reimagining Behavioral Crisis Care Inova Fairfax Hospital, Lexington Medical Center and Overlook Medical Center are using EmPATH units to replace psychiatric boarding with therapeutic spaces designed for faster stabilization, stronger engagement and fewer inpatient admissions. Original reporting by Rylee Wilson, Becker’s Behavioral Health • December 20, 2024 What changes when behavioral crisis care moves beyond the traditional ER? EmPATH units create a dedicated, living-room-style environment where patients can receive observation, assessment, medication management and clinical intervention. The three hospitals profiled by Becker’s show how physical design, treatment programming and staff engagement can change the path from crisis to recovery. Mental-health emergencies account for a growing share of emergency visits, but the conventional ED can intensify distress. EmPATH—emergency psychiatric assessment, treatment and healing—units offer an alternative built around open nursing stations, shared therapeutic space, reclining chairs and quiet areas rather than isolated beds and plexiglass barriers. Although each hospital operates its unit differently, the goal is consistent: begin treatment promptly, help more people stabilize without hospitalization and create a better experience for patients and staff. Three EmPATH programs by the numbers 14 recliners Capacity in Inova Fairfax Hospital’s newly opened EmPATH unit. 12.1 hours Average time patients spend in Lexington Medical Center’s EmPATH unit. 70% → 44% Lexington’s reported decline in patients requiring inpatient hospitalization. 8 beds Capacity in Overlook Medical Center’s EmPATH unit in Summit, New Jersey. A different environment for psychiatric emergencies EmPATH units are intentionally designed to feel less like emergency departments and more like welcoming shared spaces. Patients typically use recliners instead of beds, while open nursing stations make staff more visible and accessible. The physical environment supports observation and safety while reducing the institutional cues that can make a behavioral-health crisis more difficult. 1. Inova Fairfax designed for comfort and flexibility Inova Fairfax Hospital in Virginia opened its EmPATH unit in November 2024. The 14-recliner space includes dim lighting, televisions and quiet areas where patients can step away from the shared milieu when they need less stimulation. Behavioral-health director Sonja Flood described the environment as a core part of care—not simply a backdrop for assessment, medication management and clinical intervention. 2. Lexington shortened stays and reduced admissions Lexington Medical Center in South Carolina converted a medical office near its emergency department into a 14-bed EmPATH unit. Some leaders and staff initially questioned whether the model would deliver meaningful results. Early performance changed that view. Patients spent an average of 12.1 hours in EmPATH, compared with approximately 26 hours previously spent in the ED while waiting for a psychiatric bed. 3. Overlook refined engagement through experience Overlook Medical Center, part of Atlantic Health System, opened its eight-bed EmPATH unit in January 2024. Over the following year, staff became more attentive to the patient experience and more deliberate about how they engage people in crisis. That learning shaped treatment-planning exercises and the unit’s therapeutic curriculum, showing that implementation continues well after the doors open. 4. Staff experience improves alongside patient care Lexington leaders reported that the EmPATH environment improved job satisfaction as well as clinical outcomes. Staff felt more engaged in helping patients progress toward a different level of recovery. The model gives nurses, technicians and therapists a setting built for interaction and active care rather than prolonged supervision in an emergency holding area. More patients can return home with follow-up care Lexington reported that its inpatient hospitalization rate fell from 70% before EmPATH to 44% after implementation. More patients were able to leave with referrals for outpatient treatment. Across the model more broadly, EmPATH developer Scott Zeller, MD, has said that roughly 70% to 80% of patients who might otherwise be hospitalized can stabilize and discharge within 24 hours. Individual results depend on each program and population. State investment can accelerate adoption South Carolina approved $35 million in grant funding in 2023 to help hospitals develop EmPATH units. Lexington Medical Center was among the organizations that received support. Grant programs can help systems address the substantial upfront costs of construction, renovation and program development—especially when the necessary space does not already exist beside the emergency department. Leadership support and space remain essential Hospital leaders identified executive backing, appropriate physical space and funding as core requirements for a successful EmPATH unit. Each factor affects whether the program can operate as a true therapeutic service instead of another holding area. Space is an especially difficult constraint for hospitals with crowded campuses or emergency departments that cannot easily create a separate behavioral-health environment. The financial model remains a challenge Even when EmPATH units improve flow and reduce inpatient admissions, they may operate at a financial loss. Reimbursement does not always reflect the staffing, therapeutic programming and facility investment required to deliver the model. That tension makes sustained payer support and hospital commitment as important as early grant funding. What these three programs show Design is clinical: Lighting, open space, recliners and quiet rooms can support stabilization. Measure the care pathway: Track time in care, inpatient admissions and successful outpatient referrals. Develop the program after opening: Staff learning should continually shape engagement and therapeutic activities. Include the workforce outcome: A more effective care environment can improve staff ownership and satisfaction. Plan for sustainability: Leadership, space, grants and reliable reimbursement all influence long-term success. Article Highlights Inova Fairfax opened a 14-recliner EmPATH unit designed around comfort and decompression. Lexington reduced average behavioral-crisis care time from 26 hours in the ED to 12.1 hours in EmPATH. Lexington’s inpatient hospitalization rate fell from 70% to 44%. Overlook used its first year to strengthen patient engagement and treatment programming. Original Reporting Read Rylee Wilson’s full report on how Inova Fairfax, Lexington Medical Center and Overlook Medical Center are redesigning behavioral crisis care. Read Original Article
MUSC Health Chief Sees Promise in EmPATH Model
HEALTH SYSTEM LEADERSHIP MUSC Health Chief Sees Promise in EmPATH Model MUSC mental-health chief Lalithkumar Solai, MD, explains how EmPATH units can open emergency-department capacity, stabilize patients in a therapeutic setting and reduce avoidable psychiatric admissions. Original reporting by Ella Ruder, Becker’s Behavioral Health • February 24, 2026 What makes the EmPATH model promising for health systems? EmPATH moves appropriate behavioral-health patients from the conventional emergency department into a calmer, open therapeutic setting. MUSC sees the model as a way to begin treatment sooner, return more people safely to the community and preserve medical ED space for patients who need it. For Lalithkumar Solai, MD, the opportunity begins with the environment itself. As MUSC Health’s chief of mental health, he views EmPATH—emergency psychiatric assessment, treatment and healing—as a different front door for psychiatric emergencies. Instead of waiting in a high-stimulation medical ED, eligible patients can receive observation, medication management, therapy, coping-skills support and help reconnecting with outpatient care. MUSC allows stays of up to 72 hours, giving clinicians time to stabilize and reassess patients before deciding whether inpatient admission is necessary. The EmPATH opportunity by the numbers Up to 72 hrs MUSC’s window for observation, treatment and reassessment in EmPATH. 80% home Community-return benchmark reported by University of Kentucky’s EmPATH program. 20% admitted Share of patients admitted in the University of Kentucky comparison cited by MUSC. 50 / 50 baseline MUSC’s conventional ED split between admission and return to the community. A therapeutic space can begin treatment before evaluation The medical emergency department is designed for urgent physical care, not psychiatric recovery. Noise, bright lighting and prolonged isolation can compound distress for people already in crisis. An EmPATH unit replaces that experience with an open, calmer environment organized around engagement. Dr. Solai said the setting itself may help patients settle before a psychiatrist or other clinician completes the formal evaluation. 1. Free medical emergency beds Moving suitable behavioral-health patients into EmPATH can quickly return beds to the medical emergency department. For crowded hospitals, that capacity benefit is central to the model’s value. Dr. Solai encouraged systems with the ability to create an EmPATH unit to consider it, especially where psychiatric boarding occupies scarce ED space. 2. Use time to stabilize and reassess MUSC can keep patients in EmPATH for as long as 72 hours. That window gives treatment time to work and allows the care team to make a more informed decision than may be possible during a brief crisis evaluation. Some people who initially appear to need inpatient care may stabilize enough to leave safely with a community-based plan. 3. Build coping skills and reconnect outpatient care The stay is intended to be active treatment, not another form of waiting. Patients can participate in therapy, practice coping strategies and receive support reconnecting with outpatient clinicians and services. Those interventions can address the immediate crisis while strengthening the plan patients will rely on after discharge. 4. Match patients to the appropriate setting EmPATH is not the right environment for every presentation. Patients who are actively violent or too severely psychotic to engage may require a more secure setting and a different level of care. Separating patients according to clinical need can protect the therapeutic environment while allowing more appropriate patients to stabilize and return to the community. MUSC hopes to shift the admission balance In MUSC’s conventional emergency-department pathway, approximately half of behavioral-health patients were admitted and half returned to the community. Leaders want EmPATH to move that balance toward community discharge. Dr. Solai pointed to the University of Kentucky, where the comparison he cited was roughly 80% returning to the community and 20% being admitted. That experience offers a direction for MUSC, not a guaranteed local outcome. The model needs leadership and infrastructure Creating an EmPATH unit requires more than repurposing a room. Health-system leaders must commit physical space, operational support and a clinical pathway that connects the ED, psychiatric services and community care. Dr. Solai also noted that EmPATH has not yet been established as a universal gold standard through the level of scientific validation leaders may prefer, even though versions of the model have been implemented across many regions. Therapeutic programming is part of the design The environment needs structured ways for patients to regulate, participate and recover. Dr. Solai identified music, relaxation, group activities and group therapy as examples of the programming an EmPATH space should support. These elements distinguish the unit from a psychiatric holding area: the goal is to create conditions for active healing throughout the stay. Staffing determines whether the model works A sustainable program needs licensed counseling support, nursing care and a psychiatric prescriber—either a psychiatrist, psychiatric nurse practitioner or another qualified provider—to evaluate symptoms and manage medication. The right mix lets the unit deliver therapy, observation and medical decision-making rather than functioning only as a change of location. Payment determines whether the model lasts South Carolina Medicaid reimburses care delivered through the model, an important foundation for MUSC. Dr. Solai emphasized that payer participation is essential if health systems are expected to sustain the staffing, space and programming EmPATH requires. Start with capacity: EmPATH can release medical ED beds while psychiatric care continues nearby. Treat during observation: Use the stay for stabilization, therapy and discharge planning—not passive boarding. Define the clinical fit: Maintain other pathways for patients who cannot safely engage in an open milieu. Build the full program: Therapeutic space, structured activities and multidisciplinary staffing work together. Secure payer support: Reimbursement is a prerequisite for long-term sustainability. Article Highlights MUSC can observe and treat patients in EmPATH for up to 72 hours. The model can free medical ED beds and reduce avoidable psychiatric admissions. MUSC hopes to improve on its conventional 50/50 admission and community-return split. Dedicated therapeutic programming, clinical staffing and payer support are essential. Original Reporting Read Ella Ruder’s complete interview with MUSC mental-health chief Lalithkumar Solai, MD, in Becker’s Behavioral Health. Read Original Article
How MUSC Boosted EmPATH Utilization
EMPATH IMPLEMENTATION CASE STUDY How MUSC Boosted EmPATH Utilization From 12% to 40% Medical University of South Carolina leaders increased use of their adult EmPATH unit by changing patient-flow defaults, extending overnight psychiatric coverage, broadening eligibility and building staff confidence in the model. Original reporting by Ella Ruder, Becker’s Behavioral Health • July 15, 2026 What changed EmPATH utilization from 12% to nearly 40%? MUSC stopped treating EmPATH as an optional destination for an “ideal” patient. The health system made the unit the default setting for eligible psychiatric emergency patients, reserved its traditional holding area for people who need seclusion, expanded overnight coverage and used outside expertise to identify operational improvements. MUSC opened its eight-bay adult EmPATH unit in Charleston in July 2025. During its first six months, daily utilization remained around 12% as clinicians continued defaulting to the emergency department’s traditional psychiatric holding space, known as the D-pod. By July 2026, leaders had reversed the workflow, broadened their thinking about eligibility and expanded coverage. Utilization climbed close to 40%, while behavioral-health length of stay and waiting for inpatient placement fell substantially. MUSC’s EmPATH transformation by the numbers 12% → ~40% Adult EmPATH utilization after MUSC changed workflows and staffing. 20–22 → 12–13 hrs Average ED length of stay for patients with behavioral-health complaints. 24–28 → ~4 hrs Waiting time for behavioral-health patients who still required an inpatient bed. 552 patients Served by the adult EmPATH unit from its July 2025 opening through March 2026. The unit opened, but old habits remained MUSC’s emergency department had long relied on the D-pod, a 12-bay psychiatric holding area with a seclusion room for patients who were agitated or violent. Even after EmPATH opened, clinicians continued using the familiar space as their default. Leaders also created restrictive inclusion and exclusion criteria while searching for an ideal EmPATH patient. The combination left the new unit underused despite its eight available bays. 1. Make EmPATH the default destination Beginning July 1, 2026, MUSC made EmPATH the primary destination for psychiatric patients in the emergency department. Clinicians would move patients into the therapeutic unit, assess them there and use the D-pod only when a patient needed a more restrictive setting or seclusion. The system reinforced that change by returning six of the D-pod’s 12 bays to the medical emergency team. 2. Change culture through peer education Changing the written workflow was only part of the work. Some clinicians were more comfortable with the EmPATH model than others, so staff members who understood the service helped educate colleagues and build confidence in the new pathway. The experience shows why implementation depends on shared habits: a new physical unit will remain underused when clinicians continue following the legacy route. 3. Bring in outside operational expertise MUSC invited Scott Zeller, MD, lead consultant for EmPATH Consulting, and his team to review operations before the July workflow change. Their feedback helped leaders identify practical improvements and reconsider criteria that limited access. One recommendation was to allow appropriate intoxicated patients—or people withdrawing from drugs or alcohol—to stabilize in EmPATH when they did not have major withdrawal-related vital-sign changes. 4. Close the overnight coverage gap Previously, a psychiatrist and advanced practice provider were available only from 7 a.m. to 11 p.m. Patients arriving just after coverage ended could wait seven or eight hours before psychiatric evaluation. Under the new model, advanced practice providers cover until 3 a.m., a psychiatrist remains available by phone overnight and on-call residents cover from 3 a.m. to 7 a.m. Together, those changes provide around-the-clock clinical coverage. Length of stay fell after EmPATH opened Before the adult EmPATH unit, patients presenting with severe panic attacks, suicidal thoughts or other behavioral-health complaints spent an average of 20 to 22 hours in the MUSC emergency department. That figure dropped to roughly 12 to 13 hours. MUSC’s goal is eight to nine hours. Leaders expect some remaining difference from medical visits because South Carolina continues to face a statewide shortage of inpatient psychiatric beds. Patients awaiting inpatient care also moved faster Patients who still needed inpatient psychiatric placement previously waited an average of 24 to 28 hours in the emergency department. With more patients receiving active treatment in EmPATH and fewer competing for a bed, the reported wait fell to around four hours. MUSC also set an 11 a.m. discharge-identification target—with flexibility until 1 p.m.—to release inpatient capacity earlier in the day. The unit is supporting pediatric patients, too MUSC does not have a separate pediatric psychiatric space. Children receive psychiatric evaluation in the medical emergency department and can move into EmPATH after medical clearance, including while waiting for inpatient placement. Leaders observed that some pediatric patients improved in the therapeutic setting over a day or two and returned home rather than being admitted, although MUSC emphasized that this observation was still anecdotal. Reimbursement is improving—but sustainability is still being tested South Carolina Medicaid pays an hourly observation rate for a patient’s first 24 hours in EmPATH, followed by a daily rate of about $400. That creates revenue for care that previously generated little payment while patients boarded in the emergency department. MUSC is sharing two years of operational and financial data with Medicaid partners to determine whether the current rate supports long-term sustainability. Leaders cautioned that payment delays make it too early for final financial conclusions. Implementation lessons from MUSC Change the default: Make EmPATH the expected pathway instead of an optional alternative. Assess before excluding: Avoid overly narrow criteria that reserve the unit for an idealized patient. Cover the full day: Overnight evaluation capacity prevents avoidable waiting and stalled transfers. Invest in adoption: Peer education and outside review help clinicians move beyond legacy habits. Measure operations and finances: Utilization, length of stay, placement time and reimbursement all determine sustainability. Article Highlights MUSC increased adult EmPATH utilization from roughly 12% to nearly 40%. EmPATH became the default psychiatric destination, with the D-pod reserved as backup. Behavioral-health ED stays fell from 20–22 hours to roughly 12–13 hours. New overnight coverage
A Special Kind of ER
PSYCHIATRIC EMERGENCY CARE 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
EmPATH Units: A New Approach to Psychiatric Emergency Care
PSYCHIATRIC EMERGENCY CARE EmPATH Units: A New Approach to Psychiatric Emergency Care Psychology Today examines how EmPATH units replace prolonged psychiatric boarding with rapid assessment, active treatment and a supportive environment where many patients can stabilize within 24 hours. By William A. Haseltine, Ph.D., Psychology Today • Updated September 21, 2023 What makes EmPATH different from traditional ER care? EmPATH units rapidly receive medically appropriate patients in psychiatric crisis, including people under involuntary detention, and begin comprehensive evaluation and treatment in a calmer setting. Decisions about discharge or hospitalization are made after patients have had time to receive care and recover—not simply because an inpatient bed is the default destination. EmPATH stands for Emergency Psychiatric Assessment, Treatment and Healing. Psychology Today describes the hospital-based model as a response to emergency departments that are poorly equipped for complex psychiatric needs. Instead of leaving patients for hours or days on gurneys in noisy, chaotic surroundings, EmPATH combines prompt psychiatric intervention with a comfortable shared environment. The model aims to reduce agitation, coercive treatment and avoidable hospitalization while freeing emergency beds for medical emergencies. Why a new model is needed 4.6 days Average psychiatric boarding duration at one pediatric facility during the pandemic’s first year—more than double the prior duration. Nearly 30% Of ER beds in an average hospital were occupied by behavioral-health patients in a Massachusetts survey. <24 hours The majority of psychiatric emergencies can be resolved with prompt, appropriate intervention. Up to 80% Of EmPATH patients can achieve stability within 24 hours, according to outcomes cited in the article. The traditional ER can intensify psychiatric distress Emergency departments are designed for acute medical problems, fast procedures and constant monitoring. For someone experiencing a psychiatric emergency, the same environment may feel loud, crowded, restrictive and frightening. Limited mental health staffing means patients may receive little treatment while waiting for scarce psychiatric beds. At the same time, prolonged boarding occupies emergency capacity and increases costs without addressing the underlying crisis. 1. A central, comfortable milieu replaces isolated beds EmPATH units center care in a shared milieu room where each patient has a recliner rather than a conventional hospital bed. Patients can rest, interact with others or choose solitude while remaining visible to staff. The environment brings the calming qualities of a community crisis clinic into a hospital program capable of receiving people with acute psychiatric needs. 2. Staff work within the therapeutic environment Rather than separating clinicians behind a glass-enclosed nursing station, EmPATH integrates staff into the milieu. This makes assistance easier to access and supports frequent, informal interaction between patients and the care team. Continuous presence helps staff identify changes early, build rapport and respond before distress escalates into agitation or aggression. 3. Psychiatric assessment and treatment begin promptly The model is designed to admit medically appropriate psychiatric patients quickly and move beyond observation. Clinicians conduct comprehensive evaluations and begin medication, crisis intervention and recovery planning as soon as possible. Because treatment starts early, patients have a genuine opportunity to stabilize before the team decides whether they need inpatient care or can safely return home. 4. Supportive care reduces coercive interventions Prompt treatment and a calmer environment can reduce agitation and the need for physical restraints or forced medication. The goal is to replace a coercive experience with a therapeutic relationship that preserves dignity and encourages participation. Psychology Today reports improvements in outcomes, safety and patient satisfaction alongside fewer unnecessary psychiatric hospitalizations. EmPATH is a destination from the ER—not an inpatient substitute EmPATH serves as the next level of care for acute psychiatric patients after emergency medical screening. It does not simply substitute for an inpatient psychiatric ward. Instead, it gives clinicians a dedicated setting for evaluation, treatment and a short recovery period before determining the appropriate disposition. This distinction prevents the initial crisis presentation from automatically becoming a hospital admission. Many crises can resolve within a single day With prompt and appropriate intervention, most psychiatric emergencies can improve in less than 24 hours. Across EmPATH programs, data cited by Psychology Today indicate that as many as 80% of patients can reach stability during that period. Patients who can return home leave with follow-up plans, while those who still need hospitalization transition with a more complete assessment and treatment history. University of Iowa outcomes support the model After University of Iowa Health Care opened an EmPATH unit at its main hospital in Iowa City, admissions among suicidal patients and the time they spent waiting in the emergency department declined significantly. Peer-reviewed research on the program also found less psychiatric hospitalization, less boarding, fewer 30-day emergency returns and a greater likelihood that follow-up care was established at discharge. Clinical gains also produce operational and financial value Reducing psychiatric boarding and unnecessary hospitalization lowers costs while releasing emergency beds for patients with urgent medical needs. Fewer episodes of agitation, restraint and forced medication can also improve safety for patients and staff. Individual EmPATH units may differ in design, staffing and layout, but their shared principles connect clinical compassion with more efficient use of hospital resources. The core principles of the EmPATH model Create a therapeutic milieu: Use comfortable recliners, shared space and options for interaction or solitude. Keep staff accessible: Integrate the care team into the patient environment rather than behind barriers. Begin treatment promptly: Pair rapid psychiatric assessment with immediate clinical intervention. Allow time for recovery: Make disposition decisions after treatment and stabilization, not at the height of the crisis. Minimize coercion: Use supportive care to reduce agitation, restraints and forced medication. Article Highlights Psychiatric boarding reached an average of 4.6 days at one pediatric facility during the pandemic. EmPATH combines rapid psychiatric treatment with a comfortable, supportive milieu. Up to 80% of patients may stabilize within 24 hours. The model can reduce restraints, unnecessary admissions, boarding costs and pressure on ER capacity. Original Article Read William A. Haseltine’s complete explanation and supporting context in Psychology Today. Read Original Article
Mental Health Crisis Centers and EmPATH Units: Offering Care That Busy ERs Can’t
BEHAVIORAL HEALTH CRISIS CARE Mental Health Crisis Centers and EmPATH Units: Offering Care That Busy ERs Can’t STAT examines how crisis receiving centers, mobile response teams and hospital-based EmPATH units can provide faster, calmer and more therapeutic care than crowded emergency rooms while helping more people return home safely. Original reporting by Grace Rubenstein, STAT • April 26, 2024 What can specialized crisis care provide that a busy ER cannot? Dedicated crisis centers and EmPATH units combine rapid psychiatric assessment with active treatment, peer support, food, rest and discharge planning in environments designed to lower distress. Instead of boarding on a hallway gurney while waiting for another placement, patients can begin recovering soon after arrival. The emergency room has become America’s default entrance to psychiatric crisis care, even though most ERs were not designed for it. STAT reports that patients experiencing severe anxiety, depression, psychosis, suicidal thoughts or substance-use crises may wait for hours or days in noisy, restrictive settings with limited access to mental health specialists. Crisis receiving centers, mobile teams and hospital-based EmPATH units offer a different continuum: respond earlier, treat the immediate crisis in the least restrictive appropriate setting and connect each patient with ongoing care. The behavioral-health emergency by the numbers Nearly 6M U.S. adults visited emergency rooms for mental health emergencies in 2021—about one million more than in 2017. 3× longer Patients with psychiatric needs wait in emergency rooms compared with patients who have medical needs. >50% Of U.S. emergency rooms and general hospitals have no psychiatry services, according to a 2022 survey. Within 60 min EmPATH units aim to connect every arriving patient with a psychiatrist. The ER became the front door by default Decades of underinvestment left the United States without enough community services or psychiatric beds. People in crisis often have nowhere easy to access except the emergency room, where teams must prioritize medical emergencies and may have little or no on-site psychiatric support. The result is psychiatric boarding: patients remain in waiting rooms, hallways or treatment bays while awaiting evaluation or placement. The experience can worsen distress, increase agitation and expose both patients and staff to avoidable trauma. 1. Crisis centers begin with comfort and dignity At Pima County’s Crisis Response Center in Tucson, children and teens spend time in a bright common room with rocking chairs, games and access to an enclosed outdoor patio. Adults rest in recliners in a quieter area. Patients receive regular meals and snacks, and they can participate in groups focused on emotional processing, coping skills and art. These features support clinical care by addressing basic needs and helping patients feel safe enough to engage with staff. 2. Peer specialists make lived experience part of care Peer-support specialists at the Tucson center have personal experience with mental illness or addiction and recovery. They sit with patients, share practical coping strategies and offer a kind of credibility and hope that traditional clinical roles may not provide on their own. By asking what a person needs to feel better that day, the team frames care around collaboration rather than punishment or control. 3. EmPATH changes the physical and clinical environment EmPATH units are hospital-based crisis settings built around an open “milieu” room. Patients can rest in recliners, walk around, play games, have snacks or make phone calls while staff observe from a central nursing station. The design reduces reliance on isolation and one-to-one sitters. Just as important, it allows psychiatric evaluation and medication to begin quickly instead of making patients wait passively for an inpatient bed. 4. The goal is stabilization and a safe next step EmPATH teams monitor progress and help patients return home with medication, follow-up care and a safety plan—often within 24 hours. When a patient needs substance-use treatment or inpatient psychiatric care, staff arrange that transition. The short-stay model gives symptoms time to settle and clinicians time to determine the least restrictive setting that can safely meet the patient’s needs. Evidence from the original EmPATH model Scott Zeller, MD, helped develop the prototype EmPATH program at Alameda Health System in Oakland. STAT reports that a 2014 study found patients at the original unit boarded for an average of 1 hour and 48 minutes, compared with a statewide California average exceeding 10 hours. While most psychiatric emergency patients in California were being sent to inpatient care at the time, the Alameda program admitted only 25%; the remainder were able to return home. Newer programs are reporting operational gains Research at the University of Iowa found that suicidal patients treated in an EmPATH unit were 60% more likely to have follow-up care established within a month of discharge. Centra Lynchburg General Hospital in Virginia reported that during its unit’s first six months, mental health length of stay, inpatient psychiatric referrals and sitter costs each fell by about 20%. The reduction in sitter expense was estimated to save roughly $1 million annually. Tucson connects crisis care beyond the hospital Arizona’s model combines a crisis line, mobile response, a 24-hour receiving center, law-enforcement coordination and connections to ongoing treatment. The system accepts people regardless of insurance status and aims to resolve each crisis in the least restrictive appropriate setting. STAT reports that 80% of Arizona’s 988 calls are resolved by phone. Mobile teams resolve 70% of the remaining cases in the field, and 60% to 70% of people who reach a crisis center ultimately return home rather than enter inpatient care. 988 creates an opportunity—and a capacity challenge The national 988 Suicide & Crisis Lifeline received nearly five million calls in 2023, creating a clearer entry point for people who need behavioral-health help. But a phone number is only one part of a functioning crisis system: communities also need mobile teams, places that accept walk-ins and reliable outpatient care after the emergency passes. As of 2023, nearly 1,800 mobile crisis teams and more than 600 crisis receiving or stabilization facilities were operating across the country, with additional programs planned. Service levels and access still vary widely. What
Mental Health Crisis Leads Hospitals to Create a New Type of ER
EMPATH CARE INNOVATION Mental Health Crisis Leads Hospitals to Create a New Type of ER Bloomberg examines how EmPATH units use recliners, open space and rapid psychiatric treatment to move medically stable patients out of conventional emergency rooms, help them stabilize and avoid unnecessary hospitalization. Original reporting by John Tozzi, Bloomberg Businessweek • September 26, 2022 What problem are EmPATH units designed to solve? People experiencing a psychiatric crisis frequently arrive in emergency departments because other treatment is unavailable. They may then spend hours or days on a gurney with little active mental health care while waiting to be discharged or transferred to an inpatient psychiatric bed. EmPATH units create a dedicated pathway where treatment can begin sooner in a calmer environment. EmPATH stands for Emergency Psychiatric Assessment, Treatment and Healing. Developed by psychiatrist Scott Zeller, MD, the model is intended for medically stable patients experiencing conditions such as depression, anxiety, post-traumatic stress, suicidal thoughts or substance-use problems. Bloomberg reports that these patients can be seen quickly by psychiatric specialists, begin medication or other treatment when appropriate, and receive time to stabilize without automatically being sent to a psychiatric hospital. Why EmPATH matters by the numbers 1 in 8 Emergency-department visits nationally involve mental health concerns or substance use. 962 patients Adults included in a peer-reviewed study of EmPATH outcomes for suicidal ideation or attempts. 52% lower Relative risk of psychiatric admission after EmPATH implementation in that study. ~2/3 less Emergency-department boarding time among admitted patients in the study. The emergency room is often the default—not the right environment Traditional emergency departments are designed for medical emergencies, rapid procedures and constant monitoring. Their alarms, bright lights, security presence and limited privacy can intensify fear and agitation for someone already experiencing a mental health crisis. Psychiatric patients may receive medical clearance but little treatment for the crisis itself while they wait for another placement. The delay also keeps scarce emergency beds occupied and adds pressure to already crowded departments. 1. Medical screening comes first EmPATH does not replace emergency medical evaluation. Patients first receive screening to rule out injuries, intoxication, medication complications or other medical conditions requiring conventional emergency care. Once they are medically stable, eligible patients can transition into the EmPATH setting instead of remaining in a standard ER bay or hallway. 2. Patients enter a calmer, living room-style setting Bloomberg highlights the EmPATH unit at M Health Fairview Southdale Hospital in Edina, Minnesota, where open space and recliners create a more serene setting than a conventional emergency room. Games and activities give patients ways to occupy themselves while care is underway. The layout supports observation without requiring every patient to remain isolated in a room. Patients have space to sit, move, rest and interact with staff when it is safe to do so. 3. Psychiatric specialists begin treatment quickly Instead of waiting for an inpatient bed to become the treatment plan, patients can receive rapid psychiatric assessment, medication when appropriate, crisis counseling and help identifying the next level of care. The distinction is central to the model: EmPATH is not another holding area. It is a short-term treatment environment built to address the immediate crisis. 4. Stabilization can prevent an automatic hospital admission Some people who appear to need inpatient psychiatric care when they first arrive may be able to return home safely after focused treatment and observation. Time in a lower-stimulation setting allows symptoms to settle and gives clinicians a clearer picture of what the patient actually needs. Patients who still require hospitalization can be transferred with a more complete assessment, while others leave with follow-up care and a safety plan. Inside M Health Fairview Southdale’s EmPATH unit M Health Fairview opened Minnesota’s first EmPATH unit at Southdale Hospital in 2021. The hospital’s approach places medically stable behavioral-health patients in a therapeutic, living room-style area with rapid access to specialized support. The unit featured in Bloomberg’s reporting reflects the model’s broader philosophy: reduce unnecessary stress, make treatment available immediately and give patients a setting where stabilization is possible. A setting designed around movement and connection Recliners and games may sound like modest changes, but they represent a different understanding of psychiatric emergencies. Remaining strapped to a gurney or alone in a bare room can reinforce fear and helplessness. A more open environment can support conversation, activity and voluntary engagement with care. Staff can build rapport, monitor behavior and respond to distress while using less restrictive interventions whenever clinically appropriate. The benefits extend beyond psychiatric care Moving appropriate patients into a specialized crisis unit frees emergency beds for people with acute medical needs. It can also reduce the frustration emergency clinicians experience when they lack the time, setting or psychiatric resources to treat behavioral-health patients effectively. For hospitals, the model connects better patient care with improved flow: treatment starts sooner, boarding can fall and inpatient psychiatric beds are reserved for patients who truly need them. Why the model gained momentum after the pandemic Bloomberg’s reporting came as hospitals were reassessing mental health services after the COVID-19 pandemic intensified behavioral-health needs and exposed gaps in crisis care. EmPATH offered a practical alternative to expanding traditional psychiatric wards or continuing to board patients in the ER. The model can be adapted to different hospitals, but successful programs still require dedicated psychiatric staffing, clear eligibility criteria, reliable referral workflows and strong connections to outpatient and community care. What health systems can take from Bloomberg’s reporting Treat the crisis instead of holding the patient: Rapid psychiatric assessment and intervention are the heart of the model. Use the environment therapeutically: Recliners, open space, activities and lower stimulation can support stabilization. Reserve inpatient care for those who need it: Short-term treatment gives clinicians time to make a more informed decision. Protect emergency-department capacity: A dedicated behavioral-health pathway frees beds and reduces boarding. Connect patients to the next step: Safe discharge depends on follow-up planning and community resources. Article Highlights Psychiatric patients can spend hours or days waiting in ERs without active mental health treatment.
EmPATH Units: Better Care Brings Better Outcomes to Mental Health Crises in the ER
BEHAVIORAL HEALTH CRISIS CARE EmPATH Units: Better Care Brings Better Outcomes to Mental Health Crises in the ER EmPATH units are demonstrating what emergency psychiatric care can look like – to the benefit of hospitals, providers and patients alike. Based on reporting by Jamie Ducharme for U.S. News • June 3, 2026 A treatment-first alternative to psychiatric boarding EmPATH units move people experiencing behavioral health emergencies out of overstimulating emergency-room bays and into calmer, specialized settings where psychiatric assessment and active treatment can begin quickly. The goal is stabilization, recovery planning and a safe next step—not simply waiting for an inpatient bed. EmPATH stands for Emergency Psychiatric Assessment, Treatment and Healing. These hospital-based units are designed for people experiencing acute mental health or substance-use crises who need immediate evaluation and short-term care. U.S. News & World Report highlights the model as a significant change in emergency psychiatric care: patients receive prompt treatment in a therapeutic environment while hospitals reduce prolonged emergency-department boarding and avoid inpatient admissions when they are not clinically necessary. What the evidence shows 962 patients Adults with suicidal ideation or an attempt included in a peer-reviewed before-and-after study. 52% lower Relative risk of psychiatric admission after EmPATH implementation in that study. ~2/3 less Emergency-department boarding time among admitted patients in the study. 60% higher Likelihood of follow-up care being established at discharge. A different environment for a psychiatric emergency Traditional emergency departments are built for rapid medical triage, procedures and constant activity. For someone experiencing paranoia, severe anxiety, suicidal thoughts or another psychiatric crisis, the noise, bright lights, alarms and lack of privacy can intensify distress. EmPATH units replace that atmosphere with lower-stimulation spaces designed around safety, dignity and recovery. Many use comfortable recliners, natural light, quieter surroundings, access to food and drink, and room for patients to move rather than remain confined to a bed or hallway gurney. 1. Psychiatric treatment begins sooner In a conventional emergency department, a person may receive medical clearance and then wait hours—or sometimes longer—for a psychiatric evaluation or inpatient placement. EmPATH brings psychiatric clinicians and crisis-care resources closer to the point of arrival. Patients can be evaluated, begin medication when appropriate, receive counseling and participate in discharge planning during the same short stay. The unit functions as an active treatment setting rather than a holding area. 2. The space itself supports de-escalation The model recognizes that the physical environment can either increase agitation or help reduce it. Open sightlines allow staff to observe patients without relying on isolation, while quieter zones and flexible seating give patients greater control over where they spend time. Instead of defaulting to locked rooms, restraints or constant security presence, the environment is designed to support communication, voluntary engagement and the least restrictive form of care that is safe. 3. Basic needs remain part of care A psychiatric emergency can be made worse by hunger, exhaustion, discomfort or uncertainty. EmPATH programs commonly provide meals, beverages, blankets, showers, activities and opportunities to rest. Patients may be able to keep personal clothing and belongings when clinically appropriate. These details are not decorative amenities. They help establish trust, reduce distress and make it easier for patients to participate in evaluation and treatment. 4. Care is multidisciplinary and recovery-oriented Teams may include psychiatrists, nurses, therapists, social workers, behavioral-health technicians and peer-support specialists. Each discipline contributes to rapid assessment, crisis intervention and a realistic plan for what happens after discharge. Peer specialists can be especially valuable because lived experience may help patients feel understood and more willing to engage with care. The emphasis is on recovery and collaboration rather than control. Short stays create time for better decisions EmPATH units generally operate as short-stay observation settings. That additional time allows symptoms to settle, medication to take effect, family or support systems to be contacted and outpatient resources to be arranged. A patient who appears to require hospitalization during the first hour of a crisis may be able to return home safely after focused treatment and careful reassessment. When inpatient care is necessary, the team can make that transition with a clearer clinical picture. Fewer avoidable admissions and repeat visits Peer-reviewed research has associated EmPATH implementation with fewer psychiatric admissions, shorter boarding times and better follow-up planning. In a study of 962 adults presenting with suicidal ideation or an attempt, psychiatric admissions fell substantially and 30-day emergency-department returns also declined. These outcomes suggest that providing the right care early can help patients recover without automatically escalating every psychiatric emergency to hospitalization. Why hospitals are adopting the model Psychiatric boarding affects the entire hospital. Patients remain in spaces that do not meet their needs, emergency clinicians struggle to provide specialized care, and occupied rooms contribute to crowding and delays for other patients. By creating a dedicated pathway for behavioral-health emergencies, EmPATH units can improve patient experience while supporting emergency-department flow, inpatient capacity and staff safety. The model is flexible, but implementation matters There is no single floor plan or staffing formula for an EmPATH unit. Programs may sit within the emergency department, next to it or in a nearby facility. Capacity, length-of-stay rules and patient eligibility can vary by health system. The core principles remain consistent: rapid psychiatric evaluation, active treatment, a calming and non-coercive environment, and strong discharge planning. Hospitals also need clear referral workflows, appropriate clinical coverage and sustainable reimbursement so the new pathway is used as intended. What the EmPATH approach changes From waiting to treatment: Psychiatric care begins soon after medical needs are addressed. From overstimulation to stabilization: The environment is intentionally designed to reduce distress. From confinement to engagement: Patients can move, rest and participate in their care when safely possible. From automatic admission to the right level of care: Short-term treatment creates time to determine what each patient actually needs. From an isolated episode to a next step: Discharge planning and follow-up are treated as essential parts of crisis care. Article Highlights EmPATH units provide active psychiatric treatment in a calmer alternative to the traditional ER. Therapeutic
What is an EmPATH unit? Inside the model reshaping psychiatric emergency care
EMPATH MODEL EXPLAINER What Is an EmPATH Unit? Inside the Model Reshaping Psychiatric Emergency Care Becker’s Behavioral Health examines how EmPATH units are changing psychiatric emergency care by moving people in crisis out of traditional emergency department settings and into calmer, treatment-focused environments designed for rapid assessment and stabilization. Original reporting by Ella Ruder, Becker’s Behavioral Health • August 24, 2026 How did MUSC improve EmPATH utilization? MUSC increased adult EmPATH unit utilization from roughly 12% to nearly 40% by making EmPATH the default destination for eligible psychiatric emergency patients, using its traditional holding area only as backup, extending clinical coverage overnight, loosening overly restrictive selection criteria and bringing in outside operational expertise. EmPATH stands for Emergency Psychiatric Assessment, Treatment and Healing. It is a dedicated setting for people experiencing mental health or substance-use crises, designed to provide psychiatric evaluation and short-term treatment in a calmer environment than a conventional emergency department. The model emphasizes rapid assessment, active treatment and discharge planning. Instead of remaining on a hallway gurney or boarding in the ED for an extended period, many patients can be stabilized and connected with follow-up care without an inpatient psychiatric admission. EmPATH outcomes and operating benchmarks 12% → ~40% MUSC adult EmPATH utilization after workflow changes. 20–22 → 12–13 hrs MUSC average behavioral-health ED stay after implementation. 63.5% Reduction in inpatient psychiatric admissions reported by UK HealthCare in its first year. 29% → 65% Increase in post-discharge follow-up attendance reported by UK HealthCare. A flexible model rather than a single blueprint EmPATH programs share a common treatment philosophy, but their physical location, capacity, staffing and intake rules can differ substantially. Some units sit within a hospital’s emergency department, while others operate in a nearby or separate facility. Typical features include recliner-style seating, open low-stimulation spaces, room to move around, calming areas, group activities and access to psychiatric clinicians. The goal is to create an environment that supports stabilization rather than confinement. 1. Short, structured stays focused on stabilization Length-of-stay targets vary by organization. MUSC allows adult stays of up to 72 hours, while UK HealthCare uses a 23-hour observation framework. In both cases, the intent is to assess and stabilize quickly, then discharge with follow-up care or transition the patient to a longer-term setting when necessary. 2. Treatment goes beyond observation EmPATH care is designed to address the immediate psychiatric crisis rather than simply hold a patient while they wait. Depending on the program, treatment may include medication, crisis intervention, individual or group therapy, education, coping-skills activities and peer-support services. UK HealthCare also incorporates peer specialists with lived experience of mental illness or substance use, providing a form of support that is uncommon in traditional emergency departments. 3. MUSC learned to make EmPATH the default MUSC opened its adult EmPATH unit in July 2025 but initially saw utilization hover around 12%. Leaders found that clinicians were still defaulting to the existing behavioral-health holding area and were applying overly narrow ideas about who qualified for EmPATH. In July 2026, MUSC changed the workflow so EmPATH became the primary destination for psychiatric ED patients, with the traditional holding pod used mainly when a more restrictive setting was needed. The system also expanded overnight psychiatric coverage and brought in an outside consulting team to review operations. 4. The operational changes improved throughput After the workflow and staffing changes, MUSC reported EmPATH utilization rising to nearly 40%. Average emergency department length of stay for behavioral-health patients fell from roughly 20–22 hours to about 12–13 hours. MUSC has also expanded the model to pediatric care, reflecting a broader effort to use treatment-focused psychiatric emergency environments across patient populations. UK HealthCare built for broader inclusion UK HealthCare took a deliberately inclusive approach, including some patients who might be screened out of other EmPATH programs because of aggression or behavioral escalation. Leaders emphasized rapport-building, food and drink on arrival, allowing patients to retain personal clothing and belongings when appropriate, and close attention to early signs of distress. The organization reported restraint use below 0.01%, illustrating how environment, engagement and operational design can work together to reduce coercive interventions. Reported results at UK HealthCare In its first year, UK HealthCare reported a 63.5% reduction in inpatient psychiatric admissions and a more than 92% reduction in ED boarding time associated with the opening of its EmPATH unit. The organization also reported fewer repeat visits among frequent users and a rise in post-discharge follow-up attendance from 29% to 65%. The clinical payoff: less boarding and fewer admissions Across the systems profiled by Becker’s, the recurring benefits are fewer patients boarding in the emergency department, fewer avoidable psychiatric admissions and a care environment that gives staff more appropriate tools for treating people in crisis. The model also addresses a common source of clinician frustration: having patients with urgent psychiatric needs remain in settings designed for medical emergencies rather than active behavioral-health treatment. Financial sustainability remains a major question Clinical results do not automatically solve the reimbursement problem. MUSC receives Medicaid reimbursement for EmPATH observation care, but its leaders said the current payment structure may not be sufficient to guarantee long-term sustainability without stronger payer support. Scott Zeller, MD, vice president of acute psychiatry at Vituity and founder and creator of EmPATH Consulting, told Becker’s that length of stay is central to the financial model. He pointed to an average stay of roughly 16 hours as a benchmark associated with financial viability. What health systems can take from the EmPATH model Design for treatment, not boarding: The physical environment and care model should support immediate psychiatric intervention. Use flexible implementation: Capacity, location and staffing can vary while preserving the core EmPATH principles. Make workflows easy to follow: New units can remain underused if clinicians continue defaulting to legacy pathways. Prioritize follow-up: Stabilization is stronger when discharge planning connects patients to ongoing care. Plan for reimbursement: Clinical success and financial sustainability need to be addressed together. Article Highlights EmPATH provides active psychiatric care outside the traditional ED environment. MUSC increased