Are EDs the only option? Hospital-based alternatives to the emergency department for mental health crises: A scoping review

Mental health continues to have a significant negative impact on global health. Hospital emergency departments (EDs) serve as a first entry point for individuals in crisis, with the number of presentations to EDs for mental health continuing to increase. However, EDs remain problematic environments for patients receiving emergency psychiatric care, due to the lack of suitable space, resources and specialised staff training. The World Health Organization has acknowledged the need to restructure mental health services to prioritise accessibility and person-centred care. To address this need, a number of alternative crisis care services have been established, which provide short-term emergency psychiatric care. This scoping review aims to provide an overview of the types of crisis services available within or adjacent to a hospital service. A systematic search of CINAHL, Medline, SocIndex and PsycINFO was conducted, returning 1213 results. Following title and abstract, and full text screening, 17 sources were included in the final review. Alternative crisis care services situated within or near existing hospital sites were broadly grouped into four categories: psychiatric emergency services, crisis stabilisation or observation units, specialised services for specific populations and non-clinical crisis services. Of the included articles, 13 reported some form of service evaluation, examining a range of patient-, staff- and service-factors. Alternative crisis care services to the ED play a crucial role in providing accessible, localised support for individuals experiencing mental health crisis, potentially reducing the reliance on hospital-based services. However, to date, there is a lack of consistency in service descriptions, and comprehensiveness of service evaluations. Standardised and more thorough reporting of crisis care services is required to better understand what services are available, and the impact they are having on mental health crisis care.