Establishing a New Research Agenda for Studying Psychiatric Emergency Room Treatment Decisions

This theoretical paper addresses the need for a more sophisticated research approach to studying treatment decisions in psychiatric emergency rooms (PERs). The authors argue that traditional research has oversimplified PER decision-making by treating it as a simple choice between hospitalization or discharge, when in reality clinicians now have multiple treatment options including partial hospitalization, overnight facilities, and various outpatient referrals.

The proposed conceptual model identifies multiple factors that influence PER treatment decisions at different levels of analysis. Community resources, patient characteristics, PER staff qualifications, organizational features, and situational factors all play roles in shaping treatment outcomes. The model also incorporates the growing influence of managed care, which has fundamentally changed how treatment decisions are made by introducing cost-effectiveness considerations and requiring approval from managed care representatives.

A key contribution of this framework is its attention to mediating factors that link treatment decisions to outcomes. The authors emphasize that treatment decisions alone don't determine patient success—factors like linkage mechanisms between services and patient compliance with recommended treatment significantly influence whether PER decisions lead to positive results. The model suggests that successful outcomes depend on strong connections between emergency services and follow-up care, as well as removing practical barriers like transportation and childcare that might prevent patients from accessing recommended services. This comprehensive framework aims to guide future research that can ultimately improve the effectiveness of psychiatric emergency services and patient outcomes.