Department of Surgery, Emergency Medicine Division, Yale University School of Medicine, New Haven, CT, USA.
Acad Emerg Med. 2009 Nov;16(11):1110-9. doi: 10.1111/j.1553-2712.2009.00545.x.
The burden of mental illness is profound and growing. Coupled with large gaps in extant psychiatric services, this mental health burden has often forced emergency departments (EDs) to become the de facto primary and acute care provider of mental health care in the United States. An expanded emergency medical and mental health research agenda is required to meet the need for improved education, screening, surveillance, and ED-initiated interventions for mental health problems. As an increasing fraction of undiagnosed and untreated psychiatric patients passes through the revolving doors of U.S. EDs, the opportunities for improving the art and science of acute mental health care have never been greater. These opportunities span macroepidemiologic surveillance research to intervention studies with individual patients. Feasible screening, intervention, and referral programs for mental health patients presenting to general EDs are needed. Additional research is needed to improve the quality of care, including the attitudes, abilities, interests, and virtues of ED providers. Research that optimizes provider education and training can help academic settings validate psychosocial issues as core components and responsibilities of emergency medicine. Transdisciplinary research with federal partners and investigators in neuropsychiatry and related fields can improve the mechanistic understanding of acute mental health problems. To have lasting impact, however, advances in ED mental health care must be translated into real-world policies and sustainable program enhancements to assure the uptake of best practices for ED screening, treatment, and management of mental disorders and psychosocial problems.
精神疾病的负担是深远且不断增加的。加上现有的精神科服务存在巨大差距，这种精神健康负担常常迫使急诊部门（ED）成为美国精神卫生保健的事实上的主要和急性护理提供者。需要扩大紧急医疗和精神健康研究议程，以满足改善教育、筛查、监测以及 ED 发起的精神健康问题干预措施的需求。随着越来越多未确诊和未经治疗的精神科患者通过美国 ED 的旋转门，改善急性精神保健艺术和科学的机会从未如此之大。这些机会涵盖了从宏观流行病学监测研究到针对个体患者的干预研究。需要为在普通 ED 就诊的精神健康患者制定可行的筛查、干预和转诊计划。需要进一步研究来提高护理质量，包括 ED 提供者的态度、能力、兴趣和美德。优化提供者教育和培训的研究可以帮助学术机构将社会心理问题验证为急诊医学的核心组成部分和责任。与神经精神病学和相关领域的联邦合作伙伴和研究人员开展跨学科研究，可以提高对急性精神健康问题的机制理解。然而，为了产生持久的影响，ED 精神卫生保健方面的进展必须转化为现实世界的政策和可持续的项目增强措施，以确保采用 ED 筛查、治疗和管理精神障碍和社会心理问题的最佳实践。
