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.