It’s hard to imagine a less therapeutic environment for a person in crisis than an emergency department: crowded and windowless rooms; harsh fluorescent lights; the ceaseless ping of alarm. And yet, for every eight patients who present at an emergency department, one is there for a behavioral crisis such as psychosis, suicidality, mania, aggression, or substance use.
Often these conditions have a years-long history and can’t be treated quickly or straightforwardly, in the way that a broken bone or a knife wound might be. In some cases, showing up at an E.R. can make things worse; patients who pose a danger to themselves or others may be sedated or kept in isolation, even tethered to bedside rails so that they cannot move.