Bibliography - Laws, Policies, Standards

Resources Related to Improving Treatment of Behavioral Health Patients in Emergency Department Settings
* Resources that are not specific to behavioral health are preceded by an asterisk.

Cohen NL, Marcos LR. Law, policy, and involuntary emergency room visits. Psychiatric Quarterly 1990; 61(1): 197–204.

  • From the Abstract: “The authors present data showing that the number of mentally ill individuals brought by police officers to psychiatric emergency rooms in New York City increased by 69 percent from 1983 to 1989….The impact of these visits on hospital based psychiatric emergency rooms is discussed in terms of increased clinical and legal responsibility for the disposition of persons who are considered dangerous including those who are self-neglectful of their own essential needs.”

Lamb, HR, Weinberger, LE, DeCuir, WJ. The police and mental health. Psychiatric Services 2002; 53(10), 1266–1271.
Available at: http://ps.psychiatryonline.org/article.aspx?articleID=87145

  • This article reviews the literature on the role of the police in responding to persons with severe mental illness in the community who are experiencing crises. The authors offer recommendations on how to optimize the collaboration between the law enforcement and mental health systems to improve the care of persons with severe mental illness who are in crisis.

Stefan S, Kotar K. “Patients’ rights in hospital emergency rooms” (brochure). Center for Public Representation.
Available at: http://www.centerforpublicrep.org/litigation-and-major-cases/emergency-rooms

  • The resources provided are for the Boston, MA area, but other information is general.

Stefan, S. Emergency Department Treatment of the Psychiatric Patient: Policy Issues and Legal Requirements. Oxford University Press, 2006. Available at: http://www.centerforpublicrep.org/publications/books

  • Susan Stefan is an attorney at the Center for Public Representation, based in Massachusetts, which has an Emergency Department Initiative that seeks to improve the care of people with psychiatric disabilities who are in crisis. This book addresses issues related to treating psychiatric patients in the emergency department from the perspective of both ED staff and the individuals seeking treatment.

American College of Emergency Physicians. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. Annals of Emergency Medicine 2005 Jan; 47(1): 79-99.
Available at http://www.acep.org/workarea/showcontent.aspx?id=8826

American College of Emergency Physicians. Policy Statement: Pediatric Mental Health Emergencies in the Emergency Medical Services System. Pediatrics October 1, 2006; 118(4): 1764 -1767.
Available at: http://pediatrics.aappublications.org/content/118/4/1764.full

  • Noting that pediatric mental health emergencies frequently are not recognized or addressed, this policy statement lays out actions supported by the American Academy of Pediatrics and the American College of Emergency Physicians.

Emergency Nurses Association. The ENA has the following position statements related to behavioral health patients in the ED available at: http://www.ena.org/about/position/position/Pages/Default.aspx

  • Medical Evaluation of Psychiatric Patients. (7/2010)
  • Substance Abuse (Alcohol/Drug) and the Emergency Care Setting. (2010)

       In addition, the following joint ENA/ACEP (American College of Emergency Physicians) statements are available at: http://www.ena.org/about/position/jointstatements/Pages/Default.aspx

  • Standardized ED Triage Scale and Acuity Scale and Acuity Categorization (2004)
  • Emergency Care Psychiatric Clinical Framework (3/10/2010)
  • Consensus Statement on Suicide in Emergency Care Settings (5/2011)

Stefan S. Emergency Department Treatment of the Psychiatric Patient: Policy Issues and Legal Requirements. Center for Public Representation, Boston MA: 2006.
Available at: http://www.amazon.com/Emergency-Department-Treatment-Psychiatric-Patient/dp/0195189299

  • From the description on Amazon.com: “….Dr. Stefan uses research, surveys, and statutory and litigation materials to examine problems with emergency department care for clients with psychiatric disorders. She relies on interviews with emergency department nurses, doctors and psychiatrists, as well as surveys of people with psychiatric disabilities to present the perspectives of both the individuals seeking treatment, and those providing it...”

Lukens TW, Wolf SJ, Edlow JA, Shahabuddin S, Allen MH, Currier GW, et al. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. Annals of Emergency Medicine 2006; 47(1):79-99. Available at: www.acep.org/WorkArea/DownloadAsset.aspx?id=8826

  • This clinical policy from the American College of Emergency Physicians focuses on issues concerning the medical assessment and management of emergency department patients who present with psychiatric symptoms.

American Psychiatric Nurses Association. Seclusion and Restraint Position Statement. (Original, 2000; Revised, 2007)
Available at: http://www.apna.org/i4a/pages/index.cfm?pageid=3729

  • APNA supports a sustained commitment to the reduction and ultimate elimination of seclusion and restraint and advocates for continued research to support evidence-based practice for the prevention and management of behavioral emergencies.

International Society of Psychiatric-Mental Health Nurses (1999). The Use of Restraint and Seclusion Position Statement. Available at http://www.ispn-psych.org/docs/99Restraint-Seclusion.pdf

Zun LS, Downey LVA. Level of Agitation of Psychiatric Patients Presenting to an Emergency Department. Journal of Clinical Psychiatry 2008; 10(2):108-113. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292436/

  • This study examined the relationship between the level of agitation displayed by psychiatric patients presenting to an emergency department and the use of restraints.

Last Updated January 2014

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