Thread by @NationalCSP

Happy Friday! This is @TarakTrivedi. I'm an Emergency Physician and research fellow at @NCSP_UCLA. For #NCSPScholarFriday, I want to share research and perspectives on systems of care for psychiatric emergencies.

2/ While training @HGHED in @AlamedaCounty, I cared for hundreds of patients in psychiatric crisis, and I learned about the roles of #EMS , #Police , and #EmergencyMedicine. For Psych Emergencies, many cities have 911 systems that look something like this:

3/ Most places, Police are the de-facto response to 911 calls for psych-emergencies. As a result, Crisis-Intervention-Training (CIT) programs for police have proliferated, and even led to reduced arrests @NAMICommunicate #NCSPScholarFriday

4/ A well-supported report from @TreatmentAdvCtr indicates 1 in 4 fatal law enforcement encounters are for people with serious mental illness. At the same time, @FBI reports indicate numerous injuries to police during these encounters bit.ly/2K668Si #NCSPScholarFriday

5/ However, the vast majority of police encounters for mental illness safely result in the placement of an "involuntary hold". State laws vary significantly, but police can initiate psychiatric holds on anyone deemed "a danger to themselves or others" bit.ly/2JXuxJT

6/ Often, the Emergency Department is the only place that police can take a patient with a mental health crisis. In @AlamedaCounty , police call EMS to transport these patients to the ED. In fact, we found that 10% of all EMS encounters were for patients on involuntary holds.

7/ These patients often need psychiatric stabilization and admission to the hospital. However, for psychiatric beds, the demand is far greater than supply. A survey of @EmergencyDocs showed that some patients wait 2-5 DAYS in the ED! (known as psychiatric boarding)

8/ Psychiatric Boarding in the ED has negative impacts on patients in crisis. This excerpt is from law professor Susan Stefan's book "Emergency Department Treatment of the Psychiatric Patient" - an excellent read for anyone interested in the topic.

9/ One proposed solution has been to establish and standardize regional emergency psychiatric services. In @AlamedaCounty, patients in psychiatric crisis are transported to a regional, stand-alone psychiatric facility if medically stable. bit.ly/2nKBEiN by @AimeeMoulin1

10/ Through a partnership between @NCSP_UCLA & @alcoems, we used 5 years of EMS data to study the impact & safety of an in-the-field screening protocol, which identified low-risk patients in psychiatric crisis that could bypass the ED for the regional psychiatric facility.

11/ By developing more sophisticated systems, we can have a system of 911 response system for psychiatric emergencies that does not result in traumatizing experiences for patients and ED overcrowding. I envision one more like this. #NCSPScholarFriday

@NCSP_UCLA has provided me with amazing colleagues, mentors, time, and skills to try to look for solutions to an important problem. Please share ideas/opinions/criticisms with me @TarakTrivedi. Thanks for following along!