IN THIS ISSUE: ACLP President | Emergency Medicine | Delirium Webinar | Dlin/Fischer | What’s New on the Web | CLP2024 | A&E Abstracts
‘One step forward to address a public health emergency’
Attempts to create formal certification for emergency behavioral healthcare practitioners are close to fruition.
C-L psychiatrists are identified by the key sponsors as one of the eligible professions for this certification.
The lead sponsor for this formal Focused Practice Designation (FPD) is the American College of Emergency Medicine.
The American Board of Medical Specialties (ABMS)—responsible for improving the quality of health care through setting professional standards—will ultimately verify any certification. ABMS’ Board of Directors is due to vote on the certification bid during its February 24-26 meeting.
In its application for the FDA, The American Board of Emergency Medicine—the potential administrative board for the certification—says the aim is to recognize the expertise of physicians in emergency behavioral care.
“An FPD would also help this area of medical care more quickly evolve as an emphasis within emergency medicine and improve access to care for patients in need of unscheduled behavioral health and mental health expertise.”
Physicians with the FPD could provide a detailed mental health evaluation; initiate pharmacologic treatment quickly; arrange for safe discharge from the emergency department with coordinated, patient-family-centered outpatient treatment; and, confidently apply involuntary care and mandated treatment.
“Appropriate and timely care can be provided to patients who are boarding in the emergency department for days, weeks, or, on occasion, months, while awaiting an open inpatient psychiatric bed,” says the application. “The mental health crisis in the US and lack of access to emergency behavioral health care has created the need for more physicians to have greater expertise. A focused practice in EBH takes one step forward to address this public health emergency.”
This FPD route, rather than seeking to create a subspecialty, has been proposed because, it is believed, there is no single specialty that addresses emergency behavioral health care.
“Although residency-trained emergency physicians have foundational knowledge in providing mental health care for patients in the emergency department, physicians with expertise in EBH have acquired a greater breadth and depth of knowledge in this area of care.
“Similarly, psychiatrists, and those who sub-specialize in C-L Psychiatry, have expertise in mental health care that could be enhanced with fostering additional knowledge, skills, and abilities that optimize patient care for those who are treated in an outpatient crisis center, boarded in an emergency department, or seek care through crisis hotlines or telepsychiatry.”
The application adds: “The care of the unscheduled patient seeking acute emergency behavioral care is an evolving area of practice. Accordingly, EBH is growing into a unique body practice by melding a portion of the knowledge, skills, and abilities found in the specialties of emergency medicine and psychiatry with additional aspects of addiction medicine. Blending of these specialties has fostered the development of a unique and well-defined clinical practice whose physicians are able to deliver valuable care in novel acute care settings.”
“An EBH-focused practice could help provide better care for patients with emergency behavioral health disorders, especially in resource-poor communities.”
The number of patients with mental health disorders and intentional ingestions are rapidly increasing. ED-based opioid use disorder treatment strategies have been identified as an urgent priority by patients, patient advocates, and researchers. As many as 8% of ED patients now present to the ED after suicidal ideation or suicide attempt. “The number of patients and the acuity of symptoms therefore far outstrips the ability of outpatient community-based providers to provide sufficient care to patients with acute mental health treatment needs,” say the applicants.
Deaths from overdose and suicide are increasing faster in rural areas than more urban areas. In a recent survey, only 15% of EDs offered all safety planning elements to patients presenting after self-harm. As many as 80% of patients are not offered buprenorphine despite evidence supporting medication for opioid use disorder treatment. “An EBH-focused practice could help provide better care for patients with emergency behavioral health disorders, especially in resource-poor communities.”
As of March 2024, the American Association of Emergency Psychiatry reported 450 members, of whom 225 are physicians, who would likely seek recognition through a focused practice.
The ACLP Emergency Psychiatry SIG is discussing this prospective FPD. Outgoing co-chair Julie Owen, MD, MBA, FAPA, says: “Our SIG members are excited at the prospect of having their specialized skillset and expertise formally recognized by this special certification. This type of recognition should indeed promote needed advancement in education, research, and clinical care in this growing subspecialty practice of both Emergency Medicine and Psychiatry.”