Who he is: Scott Zeller, MD, has dedicated his career to psychiatric medicine, in practice and beyond. He’s the vice president for acute psychiatry with the physician partnership Vituity; assistant clinical professor of psychiatry at the University of California, Riverside; and past president of the American Association for Emergency Psychiatry. He serves on the editorial board for Psychiatric Times and has authored three textbooks and many articles on emergency psychiatry. He’s also the clinician who developed a fresh approach to delivering compassionate and dignified care to mental health patients within the emergency department (ED) setting with his Emergency Psychiatric Assessment Treatment and Healing (EmPATH) unit concept.
Year in review: Zeller’s EmPATH units come in response to a decade that’s seen a surge in the number of patients presenting in EDs with mental health and substance abuse issues and the realization that the at-times chaotic nature of an ED isn’t conducive to effective psychological care. Zeller’s own operational approach, the “Six Goals of Emergency Psychiatric Care,” is the basis for the unit design and includes: exclude medical etiologies of symptoms, rapidly stabilize the acute crisis, avoid coercion, treat in the least restrictive setting, form a therapeutic alliance, and formulate an appropriate disposition and aftercare plan. To support these tactics, the EmPATH unit design calls for a patient-centered space that’s an open physical environment, with a homelike, large central room called the “milieu” that promotes a sense of normalcy free of more traditional elements like barriers between patients and staff and physical restraints. In the past year, Zeller provided guidance for the newly opened EmPATH unit at Franciscan Health in Lafayette, Ind., and has been involved in the design of 11 currently operating EmPATH unit projects and another six in the pipeline. He works to guide healthcare systems through required billing codes, operational planning and training, and design of the physical environment.
Industry impact: Zeller’s approach to EmPATH unit design is guided by the idea that the physical environment has a great impact on a patient’s reaction to treatment, resulting in a correlating decrease in involuntary medication administration and physical and chemical restraints where EmPATH units have been implemented. The physical environment includes ample space, options to sit in a recliner in active therapy or fold it flat to rest, self-service stations for snacks and linens, and, frequently, an outdoor healing garden. It’s estimated that the unit design results in a 75-80 percent decrease in behavioral and mental health inpatient hospitalizations and reduced length of stay in the ED. This is inspiring greater change, as well. The Facility Guidelines Institute (FGI) will soon release new requirements for behavioral health crisis units based on Zeller’s work in its draft of the 2022 Guidelines for Design and Construction of Hospitals. In fact, Zeller was the lead clinical voice in the FGI topic group dedicated to developing the fundamental standards for all models of behavioral health units in EDs and behavioral health crisis units. His work in this arena stands to alter the landscape for mental health and substance abuse patients in an acute crisis.
