Future HealthSpaces Webinar 11 – Audience Q&A on EmPATH Units.

As a follow-up to our recent Future HealthSpaces Webinar 11, we have compiled a record of the audience Q&A. The session covered a range of practical questions on the EmPATH model, staffing, implementation challenges, and design considerations. 

This publication preserves the original questions and responses for reference.  

1. Could you point us to any research papers on EmPATH? 

Here are some useful references with strong data: 

• Kim AK, Vakkalanka JP, Van Heukelom P, Tate J, Lee S. Emergency psychiatric assessment, treatment, and healing (EmPATH) unit decreases hospital admission for patients presenting with suicidal ideation in rural America. Acad Emerg Med. 2022;29(2):142-149. doi:10.1111/acem.14374 

• Cooley A, Jasinski L, Woods M. First Emergency Psychiatric Assessment, Treatment, and Healing Unit Opens in Lexington, Kentucky. Psychiatric Times, Vol 42, Issue 4, p. 9-10. Available online: Psychiatric Times 

• Stamy C, Shane DM, Kannedy L, et al. Economic Evaluation of the Emergency Department After Implementation of an Emergency Psychiatric Assessment, Treatment, and Healing Unit. Acad Emerg Med. 2021;28(1):82-91. doi:10.1111/acem.14118 

2. What is the staff ratio? 

 The minimum is usually one staff member for every four patients, with registered nurse cover at a minimum of one to six. In practice, EmPATH units often staff more generously — at times reaching one to two during peak day shifts. The exact ratio depends on patient volumes and whether the unit is co-located with a standard Emergency Department.  

3. Is a StayingWell Plus (NHS initiative) similar to EmPATH units in the US? 

 There are similarities, but also some key differences. The most important distinction is that EmPATH units are co-located with Emergency Departments. This means they can accept patients with co-morbid physical health issues, which are often an exclusion criterion for other types of crisis centres.  

4. Any idea of how many of these units exist in the United States currently? 

 There are currently more than 50 EmPATH units operating, with projections suggesting the number will exceed 100 by 2027.  

5. Is there a maximum length of stay? 

 In most states, the maximum stay is 24 hours, though in some it can extend to 48. Ideally, the average is between 14–18 hours — long enough for treatment plans to take effect, but not so long that the unit becomes a short-stay inpatient service. Patients requiring ongoing acute care beyond that point are typically admitted to hospital beds.  

6. Slide 42 showed HOLD rooms, what are these designated for? 

Based on the blueprint, those appear to be what are often otherwise called “Secure Holding Rooms” and are used for Seclusion and Restraint. This shows how this particular unit design, while reflecting many of the EmPATH tenets, differs from EmPATH, as EmPATH Units would have “Calming Rooms” instead of Secure Holding Rooms, and would only rarely (and temporarily) convert one of the Calming Rooms, which are unlocked and non-coercive rooms for voluntary de-escalation, into a restraint bed (which typically only occurs for 1-2 out of every 1,000 patients in EmPATH Units) 

7. What do you believe is optimal staffing for EmPATH units? 

 For a 12-chair unit at peak daytime hours, a typical team might include: 

• 2–3 Registered Nurses 

• 2 Psychiatric Technicians (nurse’s aides) 

• 1 Social Worker 

• 1 Psychiatrist 

• 1 Peer Support Specialist  

9. What special considerations are needed for paediatric EmPATH units? 

 Key adjustments include the scale of furniture, zoning of social amenities, and incorporating more playful sensory features. Paediatric and youth units should also be fully separated from adult services, with their own dedicated entry and intake areas.  

10. Are there risks in not co-locating Mental Health A&E units with traditional A&E? 

 Yes. The main risk is the introduction of too many exclusion criteria, which prevents the service from fully achieving its purpose.  

11. What was the cost of deploying an EmPATH unit in Sacramento? 

 The programme was developed for around USD $4 million. It is financially self-sufficient through insurance reimbursements, with Medicaid alone saving $34 million beyond the cost of building and operating the unit. 

12. How are involuntary patients or those at risk of self-harm managed in an open EmPATH setting? 

 Units provide private sensory rooms for patients experiencing social anxiety, paranoia, irritability, autism, or similar needs. De-escalation spaces are tailored depending on individual requirements and available space, reducing the need for coercive approaches. 

13. What are the barriers to wider adoption of EmPATH units in the US? 

 The main barriers are funding constraints, regulatory challenges, and differing levels of readiness across healthcare systems. 

14. How do EmPATH units handle patients under temporary detention orders? 

 Processes vary by jurisdiction. Some facilities require firearms to be stored securely before entry, and many include first responder lounges to support rapid turnaround. 

Read more about how we can rethink psychiatric emergency care.