CHA News

Emergency Department Toolkit

Behavioral health resources for the emergency department

Special resource toolkit developed by CHA’s EMS/Trauma Committee and the Center for Behavioral Health.  Designed to help staff provide support to patients in the ED with psychosis and/or substance abuse disorders, this toolkit provides access to articles, policies, management techniques, assessment tools and more. Click the topic tabs below to access resources and information.

Study Suggests Link Between Temperature Increases and Mental Health-Related Emergency Room Visits
A new study byt he Office of Environmental health Hazard Assessment (OEHHA), which is part of the California Environmental Protection Agency, suggests that short-term exposure to increased temperatures may lead o increased emergency room visits for mental health-related outcomes, including violence and self-harm.

SMART Medical Clearance Form
Suspect new Onset Psychiatric Condition; Medical Conditions that Require Screening; Abnormal; Risky Presentation; Therapeutic Levels needed.

Behavioral Health Assessment Template
Sample Excel form to assess the extent to which numerous items are implemented.

Key Elements for Conducting a One-Hour Face-to-Face Assessment
APNA pre-recorded initial session designed as a resource for RNs who are conducting the CMS-mandated one-hour face-to-face assessment of patients in restraint or seclusion. There is an archive access fee to APNA non-members.

Assessment Guide for Key Elements in the One-Hour Face-to-Face Assessment
This APNA interactive session builds upon the information found in “Key Elements for Conducting a One-Hour Face-to-Face Assessment.” Podcast includes guided self-study examples and self-directed quizzes and answers, PowerPoint slides, a study guide, and case studies. Both sessions are approved for continuing education credit. There is an online access fee.

Medical Clearance Criteria/Exclusion Policy
Policy on Patient Assessment, from St. Joseph’s Behavioral Health Center.

Medical Clearance Criteria for Inpatient Psychiatric Treatment
Screening and documentation recommendations from St. Joseph’s Behavioral Health Center.

RN Admission Review
Sample form used by RNs to assess behavioral health patients.

Quick Guide For Clinicians: Trauma-Informed Care in Behavioral Health Services This resource equips professional care providers and administrators with information for providing care to people who have experienced trauma or are at risk of developing trauma stress reactions. It addresses prevention, intervention, and treatment issues and strategies. 
Consent Manual
Your one-stop resource for all legal requirements related to patient consent for medical treatment, release of medical information, reporting requirements and more. Learn exactly what the law requires and what you need to do to comply.

A guide that cuts through the legalese to help you navigate the Emergency Medical Treatment and Active Labor Act — or “patient-dumping” law — that was enacted to ensure patients equal access to emergency services without regard to financial or insurance status.

Mental Health Law
A handbook on laws governing mental health treatment.

Principles of Consent and Advance Directives
This handbook guides you through the basic principles of patient consent for health care treatment. In clear, simple terms this publication explains why and when consent is necessary, who may give consent, how consent for minors is different, and procedures that require special consent.

Toolkit to Reduce Ambulance Patient Offload Delays in the Emergency Department
CHA, California EMSA and other key stakeholders joined together to develop resources to reduce patient offload delays. The toolkit features process improvement models and strategies to mitigate offload delays.
New Behavioral Health Resources Available for First Responders
SAMHSA has developed new resources and materials with significant input from first responders.  A recent national survey of firefighters and emergency medical services (EMS) personnel found that many first responders experience thoughts of suicide, substance abuse issues and fear being seen as weak or unfit for duty if they ask for help.

Top Avoidable Emergency Room Visits: Alcohol, Dental Issues and Depression. (2017, September 1).  Alcohol abuse, dental conditions and depression were among the top causes of avoidable emergency room visits nationally, according to a UC San Francisco study which stressed that emergency departments are often ill-prepared to handle such conditions. 

Henderson, D. (2015, May 22) Moms’ Depression Risk May Flare a Year After Giving Birth.  View PDF

Substance Abuse and Mental Health Services Administration
(2016). Depression in Mothers: More Than the Blues. A Toolkit for Family Service Providers.
Teen Depression Brochure – Updated This brochure helps teens understand depression and how it differs from regular sadness. It describes symptoms, causes, and treatments, with information on getting help and coping. This newly revised publication from the National Institute of Mental Health (NIMH) is available online and in print. 
APNA OFFERS “TRANSITIONS IN PRACTICE” CERTIFICATE PROGRAM. Nurses entering psychiatric-mental health care, whether from the classroom or another area of nursing, often lack the up-to-date information and specialized skills they need to make the leap to practice. To help improve RNs’ confidence in their new role and ensure consistent quality of care, the American Psychiatric Nurses Association (APNA) is now offering a training program titled the “APNA Transitions in Practice Certificate Program (ATP).” The ATP program includes 15 contact hours of on-demand presentations, case scenarios, glossary, and references. Participants have 90 days from date of registration to progress through the curriculum and receive a certificate of successful completion. Four modules cover therapeutic engagement, psychiatric-mental health disorders, psychopharmacology, risk assessment, addictions, co-morbid disorders, recovery, and therapeutic environment. The training is designed to be especially beneficial to new graduates, nurses returning to practice, and nurses changing clinical practice areas. It will also be useful to those practicing in other areas who provide care to persons with mental health needs. The cost is $200 for APNA members or $250 for nonmembers.  
NAMI California
Dedicated to the strengthening of local grass roots organizations, NAMI California has 71 local affiliates and represents 19,000 people to the California Legislature and Governor on mental illness issues.

National Family Caregivers Association
Nation’s leading family caregiver organization providing education, peer support, and resources to family caregivers across the country free of charge.

CDC Grand Rounds on Preventing Youth Violence
Online video and presentation slides from the Centers of Disease Control and Prevention (CDC).  This Grand Rounds explores the societal burden of youth violence as well as the evidence-based approaches and partnerships needed to prevent youth violence and its consequences.


Al-Anon Family Groups
Support group of peers who share their experiences in applying the Al-Anon principles to problems related to the effects of a problem drinker in their lives. It is not group therapy and is not led by a counselor or therapist. This support network complements and supports professional treatment.

Peer support group for teens who are struggling with the effects of someone else’s problem drinking. Many Alateen groups meet at the same time and location as an Al-Anon group. Alateen meetings are open only to teenagers.

Military Families: Substance Abuse and Mental Health Services Administration
Supporting American’s service men and women, together with their families and communities by leading efforts to ensure that needed behavioral health services are accessible and that outcomes are positive.

National Association for Children of Alcoholics
Providing information, advice and support to children of alcohol-dependent parents and people concerned with their welfare.

SMART Recovery
Website. Self-management and recovery training. Self-empowering addiction recovery support group. Participants learn tools for addiction recovery based on the latest scientific research and participate in a world-wide community which includes free, self-empowering, science-based mutual help groups. 


Children and adults with Attention Deficit/Hyperactivity Disorder is the nation’s leading nonprofit organization serving individuals with ADHD and their families. CHADD has over 16,000 members in 200 local chapters throughout the U.S. Chapters offer support for individuals, parents, teachers, professionals and others.

The Crooked House
Website featuring video storytelling by daughters and sons of a parent with mental illness, a forum to post and read written stories about growing up with a mentally ill parent. Includes links to support groups and informational resources.

Depression and Bipolar Support Alliance
The DBSA website offers a number of ways families can receive mutual support from other families of individuals living with a mood disorder. The website has links to local DBSA chapters and family support groups, online family support groups and online discussion forums for parents and family members.

Families for Depression Awareness
Website. National nonprofit organization helping families recognize and cope with depressive disorders to get people well and prevent suicides.

Families Preventing and Overcoming Depression
The FAMpod website features a training program for the family. Family Talk Preventative Intervention is an evidence-based, strengths-focused program targeting families with parental depression. Clinicians (psychologists, social workers, nurses, and physicians) can visit FAMpod to learn about preventing and overcoming depression in families, find resources and links to supports, and take the Family Talk Preventative Intervention online training course
Payment for Medi-Cal Emergency and Post-Stabilization Mental Health Services
Guidance analyzing the various and sometimes conflicting laws governing who is responsible to pay for services rendered in an ED to Medi-Cal patients with mental health conditions.

California Health Care Almanac
This report highlights available quality data and the most recent data on national mental health care spending.
CDPH AFL 12-17
California Department of Public Health All Facilities Letter written in response to questions regarding the applicability of the Emergency Medical Treatment and Labor Act (EMTALA) to the transfer of patients with psychiatric emergencies.

The Emergency Medical Treatment and Active Labor Act is a statute which governs when and how a patient may be (1) refused treatment or (2) transferred from one hospital to another when he is in an unstable medical condition.



Health Insurance Portability and Accountability Act (HIPAA)
Health Insurance Portability and Accountability Act of 1996 – Privacy, Security and Breach Notification Rules.  This link is to the California Department of Health Care Services, Office of HIPAA Compliance resource web page.

CHA Mental Health Law Manual
Emergency Department Length of Stay for Mental Health Patients
Analysis of Emergency Department Length of Stay for Mental Health Patients at Ten Massachusetts Emergency Departments – article from the American College of Emergency Physicians published in the Annals of Emergency Medicine, 2016.

Adapting and Implementing New Strategies for Patient Centered Care
PowerPoint presentation by Contra Costa Regional Medical Center which focuses on transforming care for clients in the behavioral health setting. April 2011.

The Impact of Psychiatric Patient Boarding in Emergency Departments
Research article published by Emergency Medicine International, June 2012.

Improving Flow and Reducing Agitation in Your ED
A presentation of St.Anthony Hospital in Oklahoma. 2010.

A Literature Review: Psychiatric Boarding
Report prepared for the Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services.

Performance Improvement
Also from St. Anthony Hospital in Oklahoma, this paper describes processes to reduce length-of-stay for behavioral health patients in the ED. 2010.

A Plan to Reduce Emergency Room “Boarding” of Psychiatric Patients
A paper, originally published in Health Affairs, presenting a seven-point plan to reduce boarding. 2010.

Report on Initiative to Decrease Lengths of Stay for Psychiatric Patients in EDs
From St. Joseph’s Behavioral Health Center, this paper describes a change in policy and procedures designed to decrease patient wait times. 2010.

Report on Initiative to Decrease Lengths of Stay
A PowerPoint presentation to accompany the above paper.
Behavioral Health Design Guide
Design Guide for the Built Environment of Behavioral Health Facilities
The Transformation of Behavioral Health Care Begins in the ED
How supply and demand is intensifying our psychiatric crisis and what leading hospital executives are doing about it.

Outpatient Behavioral Health Center at Providence Little Company of Mary Medical Center – San Pedro
Video highlighting the services available at this facility in the LA area.

Behavioral Emergencies for the Emergency Physician
Reference-based text that goes beyond diagnostics, providing practical input from physicians experienced with adult emergency psychiatric patients. Available through Cambridge University Press.

Behavioral Health FAQs
Adapted from a document produced by Dominican Hospital

Competent Caring: When Mental Illness Becomes a Traumatic Event
An educational video created in support of the NAMI Provider Education Program and  used for training staff at hospitals, with a focus on emergency departments. The DVD cost is $5.50, and can be ordered online.

Ethical, Legal, and Professional Challenges Posed by “Controlled Medication Seekers” to Healthcare Providers – Part 1
American Journal of Clinical Medicine article focusing on the pragmatic, ethical and legal issues that challenge physicians and other providers who care for someone suspected or confirmed to be using deception to obtain controlled medications.

Ethical, Legal and Professional Challenges Posted by “Controlled Medication Seekers” to Healthcare Providers – Part 2
American Journal of Clinical Medicine article focusing on a general approach and attempts to minimize potential harms while still addressing legitimate medical needs.

Interagency Guideline on Opioid Dosing for Chronic Non-Cancer Pain
Washington State Agency Medical Directors educational aid to improve care and safety with opioid therapy.

Practical Management of the Suicidal Patient in the Emergency Department
Peer-reviewed report published in Emergency Medicine Report, outlining psychiatric assessment, warning signs, patient approach, restraints/involuntary holds, risk factors, and use of screening tools for the suicidal patient in the emergency room. 2014.

Psychiatric Crash Cart
Published by Advanced Emergency Nursing Journal, this article offers treatment strategies for the emergency department
Psychiatric Emergencies in Med-Surg Patients: Are You Prepared?
Published by American Nurse Today, this article offers useful advice on how to handle psychiatric emergencies.

Rapid Response Team for Behavioral Emergencies
Journal of the American Psychiatric Nurses Association article that describes the Behavioral Emergency Response Team (BERT) used effectively in managing behavioral emergencies.

Right Place, Right Time: Triaging California’s Mental Health Care Delivery System
PowerPoint presentation showing a designed project to assess and quantify the impact of patients with unmet mental health needs on emergency departments

Trauma-Informed Care
A new Treatment Improvement Protocol on Trauma-Informed Care (TIP) in Behavioral Health Services.  This document discussed patient assessment, treatment, and planning strategies that support recovery and building a trauma-informed care workforce.  It is part of the TIP series from the Substance Abuse and Mental Health Services Administration (SAMHSA). 

Emergency Care Psychiatric Clinical Framework 
Our collective goal for the provision of psychiatric and substance use disorder treatment in the emergency department, is to provide care that meets the Institute of Medicine’s Six Quality Aims of safe, effective, timely, efficient, equitable, and patient-centered care.

Psychiatric Boarding in U.S. EDs: A Multifactorial Problem that Requires Multidisciplinary Solutions
Report on  solutions to reduce psychiatric boarding in the ED released by The George Washington University.

Prescription Drug Abuse and Safe Prescribing webinar 

Suicide Prevention Help and Resources
Suicide prevention resource from 

Management of Suicidal Patients Emergency Departments
A presentation describing recent innovations in care.

Suicide Prevention Research
National Institute of Mental Health video, August 28, 2011. NIMH researcher, Dr. Douglas Meinecke, talks about critical suicide prevention research.
Suicide Prevention at Mercy Health Center
An overview of one hospital’s methods.

Suicide Prevention Webinar Online
A recording and slides from a training on “Safety Planning and Means Reduction in Large Healthcare Organizations” (originally presented December 16) is now online at (Find the links in the box titled “Recorded Webinars.”) The webinar discusses ways to maximize the effectiveness of a safety plan, to develop an organizational policy for lethal-means reduction, and to incorporate input from people with lived experience.

Suicide Risk Assessment and the Columbia-Suicide Severity Rating Scale (C-SSRS) 

Suicide Risk Assessment & Safety Planning: A Stand-Alone Intervention
PowerPoint Presentation developed by MIRECC regarding veteran suicides. Based on work supported, in part, by the Department of Veterans Affairs.

Caring for adult patients with suicide risk:  A consensus guide for emergency departments  SAMHSA’s SPRC released a new resource which provides research- and consensus-based practices in decision support, initial interventions, and discharge planning for emergency departments (ED). The ED Guide addresses specific objectives articulated by the 2012 National Strategy for Suicide Prevention, namely, to promote a continuum of care, safety, and well-being for ED patients treated for suicide risk; to collaborate with other health care providers to provide rapid and appropriate follow-up treatment; and to develop standardized protocols that direct clinical responses based on individual patient risk profiles. 

Suicide Prevention Information
This website offers helpful information if you suspect someone you know may be thinking about suicide.

New Behavioral Health Resources Available for First Responders
SAMHSA has developed new resources and materials with significant input from first responders.  A recent national survey of firefighters and emergency medical services (EMS) personnel found that many first responders experience thoughts of suicide, substance abuse issues and fear being seen as weak or unfit for duty if they ask for help.

Suicidal Thoughts and Alcohol Abuse
This guide can help lead the way to cleaner, happier living by outlining the relationship between alcohol abuse and suicidal thoughts and how to overcome both.

Life-Saving Post-ER Suicide Prevention Strategies are Cost Effective
A study led by research at the National Institute of Mental Health (NIMH) modelled the use of the approaches in emergency departments and found that three interventions designed for follow up of patients who are identified with suicide risk in hospital EDs save lives and are cost effective relative to usual care.

Resources for Suicide Prevention Week
Materials and Resources that can assist in planning activities and events in your county and community.  Get the 2017 Suicide Prevention Toolkit.

American Foundation for Suicide Prevention
AFSP is a national organization dedicated to understanding and preventing suicide through research, education and advocacy.
Mental health information provided in an ad-free environment.

National Institute of Mental Health
NIMH’s Suicide Prevention webpage offers publications, science news, treatment information,  and online resources for suicide prevention.

National Suicide Prevention Lifeline
A 24-hour, toll free, confidential suicide prevention hotline. Dialing 1-800-273-TALK wil route the caller to the nearest crisis center in the national network. Centers provide crisis counseling and mental health referrals day and night.

San Francisco Suicide Prevention
Community-based 24-hour telephone crisis center providing emotional support, education, assistance and intervention.

Suicide Prevention Resource Center
SPRC has a new website with significant updates, particularly to our menu items. SPRC is a federally supported resource center devoted to advancing the National Strategy for Suicide Prevention. SPRC provides technical assistance, training and material to incrase knowledge and expertise of suicide prevention practitioners and professionals. This website has a tremendous amount of resources, including a searchable library.


Nurse Suicide is Real.  Don’t Ignore It.
Nurse leaders should recognize and responde to factors that contribute to nurse suicide.  Here are three actions you can take to prevent it.

Suicide Prevention in an Emergency Department Population
The ED-SAFE Study to determine whether an ED-initiated intervention reduces subsequent suicidal behavior. (April 29.2017)

CDC Report on Suicide Trends Among Persons Aged 10-24
Reviews statistics for years 1994-2012

Evaluation of ED Educational Campaign for Recognition of Suicidal Patients
An article on evaluation of ED patients for suicide Risk.  PubMed (free article) published February 2012.

Long-term Outcomes for the Promoting CARE Suicide Prevention Program
Long-term look at suicide risk from adolescence to young adulthood for former participants in Promoting CARE, an indicated suicide prevention program.  PubMed (free article), published June 2011.

Mindfulness in the Treatment of Suicidal Individuals
This article reviews theory and evidence that support mindfulness and psychological acceptance as a means to target experiential avoidance in suicidal clients and thereby reduce the risk of suicide. PubMed (free article) published January 2012.


2015 National Patient Safety Goals  
(NPSG 15.01.01)
Identifying patients at risk for suicide.  (Scroll down to Goal 15)
After an Attempt
An ED medical provider’s guide for taking care of suicide attempt survivors.

Columbia-Suicide Severity Rating Scales (C-SSRS)
The first suicide assessment tool, made available through Columbia University Medical Center, to reliably and consistently predict potential suicide attempts among those who had previously made an attempt.
Is Your Patient Suicidal?
Suicide Prevention Resource Center’s poster that provides ED practitioners with information on recognizing and responding to acute suicide risk.

Using the “Is Your Patient Suicidal” Poster Training and Triage Guide
Suicide Prevention Treatment Center’s set of instructions for ED staff who are displaying the poster and referencing for the resource guide.

Joint Commission Sentinel Event Alert on Suicide
A follow-up report on preventing suicide with a focus on medical/surgical units and emergency departments.

Joint Commission Standards BoosterPak for Assessing Suicide Risk
Information on how to obtain the BoosterPak for assessing suicide risk. June 22, 2011. It is available to accredited organizations on the TJC Connect extranet site.

Older Adults and Depression
NIMH online fact sheet about older adults at risk for depression and/or suicide.

National Alliance on Mental Illness ED Resource Toolkit
This NAMI toolkit features three brochures: one each for individuals who have attempted suicide and their families about the importance of obtaining follow-up care, and one brochure for medical professionals who work in emergency departments.

Psychiatric Emergency Brochure
An example of a tri-fold brochure that can be customized with information for your area.

Instructions for Use

Brochure – Side One

Brochure – Side Two

Quick Guide for Clinicians: Trauma-Informed Care in Behavioral Health Services
This resource equips professional care providers and administrators with information for providing care to people who have experienced trauma or are at risk of developing trauma stress reactions. It addresses prevention, intervention, and treatment issues and strategies.

Sample Crisis Card
An example of a crisis information card, as used by Loma Linda University Behavioral Medicine Center.

Suicide: A Major, Preventable Mental Health Problem
Facts about suicide and suicide prevention among teens and young adults. Fact Sheet available online and in print

Suicide in America: Frequently Asked Questions
National Institute of Mental Health trifold available online and in print (English & Spanish)

Suicide in the U.S.: Statistics and Prevention
National Institute of Mental Health (NIMH) online fact sheet.
Addiction Group
There are many treatment options available for those struggling with a substance use disorder (SUD) or alcohol use disorder (AUD). The type of treatment needed depends on the patient’s unique situation, level of addiction, and the kind of substance(s) he or she is abusing. In some cases, more than one treatment is necessary.

Website providing information 12 step programs for alcohol recovery.

SHOUT – Support for Hospital Opioid Use Treatment
Providing clinical leaders with the tools necessary to start and maintain patients on effective treatment for opioid use disorder.

Opioid Overdoses Treated in Emergency Departments
Centers for Disease Control and Prevention identifies opportunities for action.

Detox Centers and Drug Rehabs
Website offering an extensive list of detox centers, rehab programs and treatment facilities.

Alcohol Rehab Guide
Online guide with information on treating alcoholism, support options, resources and blog.

A Roadmap to Behavioral Health
The Centers for Medicare & Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have released this roadmap as a resource for consumers that provides information about mental health and substance disorder services, including definitions about behavioral health terms and guidance for finding a behavioral health provider.
NIAAA Alcohol Treatment Navigator
The Navigator’s simplified search tool can help you find a list of accredited alcohol treatment programs near you.

Top Avoidable Emergency Room Visits: Alcohol, Dental Issues and Depression. (2017, September 1).  Alcohol abuse, dental conditions and depression were among the top causes of avoidable emergency room visits nationally, according to a UC San Francisco study which stressed that emergency departments are often ill-prepared to handle such conditions.

Drug Rehab and Addiction Recovery Resources provides Addiction, Treatment and Rehab Guides, along with information on Substances.

Addiction, Treatment & Recovery Library
Links to a library of articles covering a wide range of rehab-related topics, from intervention and detox to cost and location.

Surgeon General’s Report on Alcohol, Drugs and Health
Key information and findings related to substance use, misuse, and substance use disorders are detailed by chapter.   Last chapter presents a vision for the future, five general messages, their implications for policy and practice, and recommendations for specific stakeholder groups.  Also provides supplementary materials.

National Institute on Drug Abuse
NIDA’s mission is to lead the Nation in bringing the power of science to bear on drug abuse and addiction. This charge has two critical components. The first is the strategic support and conduct of research across a broad range of disciplines. The second is ensuring the rapid and effective dissemination and use of the results of that research to significantly improve prevention and treatment and to inform policy as it relates to drug abuse and addiction.

Addiction Center
Addiction Center was founded by recovering addicts and health professionals to provide the most up-to-date information on various addictions and reviews of top treatment centers across the country. We are not a treatment center, but our network of centers across the country aim to provide outlets for people seeking help. Founder Chris Carberg is a recovering addict who received excellent care and wanted to help others learn about their own struggles and find treatment. – Ultimate Guide to AA’s Big Book
The Big Book is a thorough and comprehensive resource designed to give people from all walks of life the information, encouragement, and resources they need to effectively deal with their drinking addiction.

Trends in Emergency Department Visits Involving Mental and Substance Use Disorder
The rate of emergency department (ED) visits per 100,000 population related to mental and substance use disorders (M/SUDs) increased substantially between 2006 and 2013.  Statistical Brief #216 provided by the Healthcare Cost and Utilization Project provides data regarding trends ED visits involving mental and substance use disorders.