Integrating Behavioral Health in the Emergency Department and Upstream

Laderman M, Dasgupta A, Henderson R, Waghray A, Bolender T, Schall M. Integrating Behavioral Health in the Emergency Department and Upstream. IHI Innovation Report. Boston: Institute for Healthcare Improvement; 2018. (Available at ihi.org)

Emergency departments (EDs) throughout the United States lack the capacity to support individuals with a range of behavioral health needs, leading to poor outcomes and experience of care for individuals and families, overburdening ED staff, negatively impacting patient flow and throughput in the ED, and raising costs for health systems.

The primary aim of the two IHI innovation projects described in this report was to identify gaps in care for individuals with behavioral health needs that present to the ED and best practices to fill those gaps; and to develop a theory of change and specific change ideas for integrating behavioral health care into emergency departments.

The innovation projects also researched ways to bolster relationships with “upstream” community partners and resources to better support individuals in this patient population. These upstream services and supports are essential to ensuring that individuals with behavioral health needs receive the right care, in the right place, at the right time, rather than needing to seek care in the ED by default.

This report discusses barriers to integrating behavioral health in the ED; presents the results of a literature scan of existing models to address behavioral health needs in the ED and in communities; and identifies five drivers (emerging from six key themes from existing approaches) that form the building blocks of a theory of change for making improvements in this area.​

Background

From March 2018 to August 2019, IHI partnered with Well Being Trust on the 18-month initiative, Integrating Behavioral Health in the Emergency Department and Upstream Learning Community.