This chapter steps back and examines the factors that make the treatment of people with psychiatric disabilities different from medical patients in emergency department (ED) settings. In addition to the mandate to assess and involuntarily detain certain people with psychiatric disabilities — a mandate that does not extend to medical patients — another difference is the issue of the secondary utilizer of the ED. “Secondary utilizers” include the family members, police officer, or service provider who brings an individual to the ED — often against that individual's will — to solve a family problem or social conflict. Sometimes this happens at night, when regular treatment and service providers are not available. Sometimes the service providers seek a quick solution to a difficult problem by taking a client to the ED. In this way, the availability of EDs may contribute to inappropriate utilization individually and on a larger social level. Emergency departments provide cover for inadequate social service agencies suffering from budget cuts that make it difficult or impossible to provide the preventive and crisis stabilization services, medication, or sometimes just the reassurance and company that individuals in psychiatric crisis need. Thus, the larger solution to some ED problems must come from outside the hospital. At the same time, there is much that hospitals can do to improve their treatment of their patients with psychiatric disabilities without larger social change, and some hospitals are leading the way.
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