Rethinking Psychiatric Emergency Care: Insights from the EmPATH Model

At a time when both the NHS and international healthcare systems are under acute strain, psychiatric emergencies stand out as a pressure point. Patients in crisis often face long waits, unsuitable environments, and fragmented care. Against this backdrop, the EmPATH model — Emergency Psychiatric Assessment, Treatment and Healing — offers an alternative.

A Future HealthSpaces webinar brought together Dr Scott Zeller (Vituity), Stephen Parker (Stantec), and Dr Jane Grassie (NHS Fife) to explore what the EmPATH approach could mean for both US and UK systems. What emerged was a clear sense of the model’s impact: a blend of therapeutic philosophy, evidence-backed outcomes, and practical design principles that challenge the current status quo.

From Boarding to Therapeutic Stabilisation

Traditional emergency departments (EDs) are not designed for psychiatric presentations. Patients experiencing acute mental health crises are often “boarded” for extended periods — strapped to gurneys, observed intermittently, but without meaningful therapeutic engagement.

As Dr Zeller explained: “Usually [patients] just get regular rounding for vitals from the nurses and they'll get a food tray a couple of times a day. It's a really unfortunate situation... we've got plenty of studies that show the regular emergency department environment actually can make psychiatric emergency patients symptoms worse. It's frightening, it's claustrophobic, they feel like they're being punished or imprisoned and it's no fault of the [ED]... What's really great for somebody having a cardiac infarction may not be the greatest environment for somebody having a behavioural emergency.”

Located adjacent to EDs, EmPATH units operate with a “no wrong door” philosophy, accepting nearly all psychiatric presentations other than those with acute medical conditions. Patients receive immediate psychiatric evaluation and, where needed, treatment initiation from prescribing clinicians. The emphasis is on stabilisation and healing, not containment.

Demonstrated Clinical Outcomes

The data supporting EmPATH is compelling. Across 50 units in the US:

• 75% of patients are discharged home within 24 hours, compared to traditional pathways where many would require multi-day inpatient stays.

• Restraint use has fallen by 99% relative to standard ED practice.

• A University of Iowa study recorded a 53% reduction in inpatient admissions and a 25% decrease in 30-day returns, with length of stay cut from over 16 hours to just 4.

Perhaps most tellingly, outpatient follow-up rates are 60% higher compared to patients discharged from inpatient wards, underscoring the model’s ability to support continuity of care.

Therapeutic Environments and Trauma-Informed Design

The built environment is central to EmPATH’s success. Units are designed around open spaces, recliner seating, and freedom of movement. Patients can access refreshments, sensory rooms, and outdoor courtyards. Staff are intermingled rather than separated by traditional nursing stations, maintaining constant observation while reducing barriers to therapeutic engagement.

As Stephen Parker noted: “We see a massive investment of enthusiasm as well as the dollars and space required because it takes the political will of the organisations to commit to it, knowing that they will have better outcomes in terms of the patient’s metrics and so forth. But generally just as human beings, treating human beings in more humane ways in more humane spaces.”

This trauma-informed approach recognises that environments designed for medical trauma can exacerbate psychiatric symptoms. Instead, EmPATH environments seek to provide dignity, choice, and calm at a point of acute crisis: “Anybody who's been an EmPATH will tell you this is exactly the opposite. It's like a library or a church in there. It's calm, it's mellow, everybody's getting along. It's a remarkable experience.”

Financial and System-Level Benefits

Beyond patient outcomes, EmPATH has demonstrated significant system gains. One California unit saved $34 million in 2.5 years through avoided inpatient utilisation. For the University of Iowa, improved patient flow translated into nearly $1 million in ED operational savings — from reduced security costs to better bed utilisation.

For acute hospitals under pressure, the model also frees capacity. By moving psychiatric patients into purpose-designed units, emergency departments can refocus on trauma, cardiac, and other medical emergencies.

Overcoming Barriers: The UK Context

For the NHS, parallels with the US boarding crisis are clear. Psychiatric patients in the UK wait twice as long as others in EDs, with delays often exceeding 12 hours. Meanwhile, the UK has the lowest psychiatric bed capacity in Europe per 100,000 people.

Yet, as Dr Grassie emphasised, implementation cannot ignore local challenges. Space, funding, and staffing remain critical barriers, while the legacy of the four-hour target clashes with the longer stabilisation times needed for psychiatric recovery.

Stigma also plays a role, as both Dr Grassie and Dr Zeller aptly observed. To quote Dr Zeller: “there’s often a fear, if we build this, they will come. And what we try to make clear to everybody is they’re already there… What EmPATH actually does is reduces their return.”

The perception of psychiatric care as less urgent than other specialties remains a cultural barrier to investment — despite clear parallels with successful, purpose-designed spaces in oncology such as Maggie’s Centres. As Dr Grassie mentioned: “Maggie's centres are centres for cancer care that have been rolled out across the UK in the last decades… they're phenomenally designed, beautiful buildings co located with acute hospitals to provide a calm, therapeutic, lovely environment for those families and patients who have been diagnosed with cancer [and] are undergoing treatment, including those people who have been bereaved by cancer. And it's a fantastic thing. Why can't we do something similar for mental health?”

A Collaborative Model for the Future

Staffing models also reflect a shift in philosophy. EmPATH units integrate psychiatrists, nurses, social workers, and peer support specialists with lived experience, creating teams able to manage the full spectrum of psychiatric emergencies and comorbid substance use.

Innovations in paediatric and adolescent care are also emerging. As Dr Zeller described, “sometimes there’s even EmPATH units, which are adults on one side of a wall and paediatric patients the other. They share a same nursing station where it’s just kind of split down the middle. The nurses can see both sides, but the patients don’t commingle… So it works economically — we don’t have to have double staff.”

Towards Wider Adoption

There are now 50 EmPATH units operating in the US, with over 100 expected in the near term. Federal recognition of EmPATH as the highest-acuity, lowest-barrier form of crisis care underscores its status as a new standard of practice.

While the UK context presents unique barriers, the international evidence base offers a compelling case for change. As Stephen Parker reminded the audience, commitment requires more than capital: it requires leadership willing to prioritise humane, evidence-based solutions to a growing crisis.

The discussion reflected both urgency and optimism. Far from being a speculative idea, EmPATH was presented as a practical, proven, and humane model — one that reframes psychiatric emergencies not as logistical problems to be managed, but as opportunities for recovery to be enabled.

Looking to understand more detail about EmPATH read the Q&A from the webinar

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