Safe spaces: scoping report

Annex B

International: Good Practice Examples:

EmPATH Model - USA

The term EmPATH^[43] unit stands for "Emergency Psychiatric Assessment, Treatment and Healing unit. These hospital-based outpatient programs rapidly admit all medically appropriate patients in psychiatric crisis, including those under involuntary psychiatric detention. Unlike being an alternative to inpatient care, the EmPATH unit serves as the destination for acute mental health patients from the ER. Decisions about patient dispositions are made after comprehensive psychiatric evaluation, treatment, and a recovery period in the unit's setting.

Psychiatry Today describes these units as combining the calming, supportive atmosphere of community crisis clinics with the capacity to admit even the most acute psychiatric patients. EmPATH units have shown significant improvements in outcomes, safety, and patient satisfaction. They have also substantially reduced the need for coercive measures, instances of agitation and physical restraints, and unnecessary psychiatric hospitalisations, all while being more cost-effective than the traditional approach. The fiscal benefits of emPATH units include reduced boarding costs and unnecessary hospitalisations, while also freeing up ED beds for other medical emergencies.

EmPATH units exhibit diversity in their designs, staffing, and layouts, but they adhere to several core principles:

• A central, comfortable environment where patients are situated. Instead of individual beds, patients have their own recliner chairs allowing for social interaction or solitude.
• Staff presence is integrated into unit, ensuring quick and supportive assistance without a glass-enclosed nursing station.
• Prompt psychiatric assessment and treatment implementation to achieve better outcomes.
• The combination of prompt assessment, treatment, and a supportive environment leads to remarkable results, reducing the need for physical restraints and forced medications.
• The effectiveness of EmPATH units has been demonstrated nationwide in acute behavioural crisis situations, with data indicating that up to 80 percent of patients can achieve stability within 24 hours.

After the University of Iowa, Health Care opened such a unit in its main hospital building in Iowa City, the number of suicidal patients admitted and the length of time they waited in the ER dropped dramatically^[44].

The Royal Infirmary in Edinburgh’s ED is interested in exploring the establishment of an EmPATH unit but we understand that NHSL is not currently able to provide funding. Lothian Mental Health Unscheduled Care leads are therefore engaging with other stakeholders including Police Scotland and Third Sector to explore further.

St Joseph’s Health Care Foundation (Toronto, Canada)

The Centre^[45] receives annually 64000 Visits from seeking support for mental health or addiction, 6700 Emergency visits for mental health and/or addiction care and 1900 Children and youth received care in the Child, Adolescent & Family Mental Health Unit.

The hospital provides a wide range of mental health interventions which include; Addiction Services, Adult Inpatient Mental Health Unit, Adult Outpatient Mental Health Unity, Child Adolescent and Family Mental Health, Outpatient Withdrawal Management Services, Withdrawal Management Residential Services.

Following funding from donors, the hospital has recently implemented a safe unit for adults and youth in crisis adjacent to the Emergency Department, renovated Child and Adolescent Inpatient Mental Health Unit, outpatient care area, and recently opened the Mental Health Short Stay and Transitional Age Youth Unit.

In April 2019, a new Mental Health Emergency Services Unit (MHESU) opened. The MHESU is the first point of contact for people who are in crisis and in need of care. Services include: Assessment, Crisis Intervention and stabilization, Brief counselling and Short-term critical stress management. This state-of-the-art facility was designed with input from patients to create a truly patient-centred experience. It was recognised that environment plays a role in how people feel and has an effect on the healing process. The comforting, modern new space helps reduce anxiety, calm fears and provide the highest level of safety for both patients and staff.

There are separate areas for adults and children, each with their own lounge, private rooms, and accessible washroom facilities. All of the eight private patient rooms have natural light, comfortable furnishings and glass walls that can dim to help patients sleep or rest. Patient and staff safety is also greatly improved with thirty-two cameras throughout the unit visibility and safety is optimised. Card swipe access to all areas also ensures quick access for patient and staff assistance and reduces opportunities for unplanned exit.

Psychiatric Alcohol and Non-Prescription Drug Assessment (PANDA) Unit (Sydney, Australia)

Sydney opened Australia’s first Psychiatric Alcohol and Non-Prescription Drug Assessment (PANDA) Unit^[46] to provide specialist care to patients experiencing drug or alcohol-related psychotic episodes. The purpose built unit is located within the Emergency Department, and will enable people presenting to us with addiction and complex mental health issues to receive the care they need in a safe and dignified space, while still being able to draw on the expertise of the Mental Health, Clinical Pharmacology and Alcohol & Drug teams.

This Unit reports^[47] positive outcomes for individuals and staff as well as a 50% reduction in violent incidents since the unit’s inception, amongst a cohort that would typically present the highest risk group for security threats.