An increasing number of psychiatric and mental health patients are being admitted to Emergency Department’s (ED) in nearly every hospital in the U. S. It’s heavily taxing EDs and community hospital resources. 

Part Three of the series “Treatment of Psychiatric Patients in the E.D.: What You Need to Know,” by Isaac Abraham, MSN, RN.

What are the most important steps to take to have a well-prepared emergency department for the treatment of mental health patients?

Part Three of the series “Treatment of Psychiatric Patients in the E.D.: What You Need to Know,” by Isaac Abraham, MSN, R

Here are the most important first steps to take:

Step 1

Get together with the hospital administration and the Emergency Department (ED) staff and start with a clear statement of intent:

We will improve the treatment and care of mental and behavioral health patients in this department. To do that, we need the involvement and effort at every level. We want input from everyone involved. 

A well-prepared ED means you have thought things through and planned carefully. You have a documented step-by-step process about what actions to take if a patient comes in and begins to act out.  You know what to do (have a process and steps to take place) if there is a patient who is a high suicide risk.

What is Code Help?

Something that has worked well in my experience is what’s called “code help.” A  predetermined code is announced over the communications systems to designated staff when there’s an event requiring assistance. Resources from other areas and units in the hospital report to the ED and help manage the problem.  Everyone works together (as alluded to in part 2 of this series of articles). It’s a codified plan. But, and this is important, it has to be practiced to make it work; practice and repetition. It makes things easier for the ED staff, but more importantly, it provides better care for the patients.

Step 2

All the staff should be trained in de-escalation techniques for dangerous behaviors.

If you don’t train in de-escalation techniques before an event, your staff might get too focused on the behavior of the patient and actually increase their agitation, making the problem worse.

De-escalation techniques have to be reflexive. Practiced. Routine.

Be Boring

At the very least, if not all the staff have are trained in de-escalation techniques, teach them to be boring and keep the patient bored.

You heard me. Be boring and keep the patient bored.

If the staff doesn’t know de-escalation techniques, but they can keep the patient bored, it calms the situation. It is not going to be one hundred percent effective for every patient, but it’s the place to start.

Be Calm

Also, in my experience, I’ve found (you have to take a deep look at yourself as a practitioner, no matter whether you’re a doctor, nurse, mental health worker, or CNA)  that if you remain calm, it helps keep the patient calm. It works. It’s simple, but it works.

Be calm and boring. It’s a soothing balm and de-escalates.

Step 3: Patient Assessment has to Happen

A complete physical and emotional assessment of the mental health patient has to happen. Has to happen. There may be other underlying physical issues to be treated.

And… listen to the patient.

“A lot of patients have told me one of their biggest concerns is that no one ever listens to us (mental health patients). I’ve heard that for years. But hear me,  five minutes of talking can prevent you from having an hour trouble or an event that spirals out of control.”

What You Need to Know

Be calm. 

Be boring. 

Listen to the patient. 

Treat these patients no differently than you would a member of your own family.  If you do that, you will have significantly improved the care of mental health patients in the emergency department.


This is the final installment of the series “Treatment of Psychiatric Patients in the E.D.: What You Need to Know,” by Isaac Abraham, MSN, RN.

Isaac Abraham has worked with Compass Clinical Consulting for many years. He’s one of the most truly authentic, compassionate, skilled, gifted and exceptional leaders (and teachers) in healthcare consulting. Isaac specializes in the treatment of Mental Health Patients in the Emergency Department (ED). A tireless advocate for psychiatric patients, Isaac shares his hard-earned insights and illuminating lessons learned throughout his career in this three-part series of articles.

Read Part 2:How to Deal with the Growing Influx of Mental Health Patients in the Emergency Department?

Read Part 1:Treatment of Mental Health Patients in the Emergency Department: What You Need to Know.

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