Q&A: Emergency psychiatrists meet ‘the need where the crisis exists’

Following the COVID-19 pandemic, the need for mental health care among all age groups is significantly prevalent, while the need for emergency psychiatrists continues to play a role in other aspects of the field.

Tony Thrasher, DO, DFAPA, a board-certified psychiatrist and medical director of crisis services in the Milwaukee County Behavioral Health Division, currently serves as the president of the American Association for Emergency Psychiatry.

Healio spoke with Thrasher about the genesis of the AAEP, its mission, how its services can be expanded and the need for emergency psychiatry in a country grappling with mental health issues.

Healio: Can you talk about AAEP in terms of its purpose, what unmet needs the organization seeks to remedy, how you became involved and what is its current footprint?

Tony Thrasher

Thrasher: We are an affiliate of the American Psychiatric Association, so the predominance of our members are psychiatrists. However, we also welcome all different scopes of mental health care, and we have a very large contingent of our group that are emergency physicians. We pride ourselves in focusing on improving the patient experience in giving better emergency mental health care. That’s why our footprint is fairly broad; we can encourage lots of different practices and backgrounds. We work on everything from the community to the hospital.

Healio: What are the technical specs of emergency psychiatry — the processes, treatments, locations where the practice exists?

Thrasher: For most people who are dealing with mental health crises, an inpatient hospital unit may not be necessary. Most people think of [psychiatry] as outpatient or inpatient, but the truth is there’s a lot of aspects that happen in between, and that’s where emergency psychiatry comes into play.

What emergency psychiatry is focused on is meeting the need where the crisis exists. We do that by making people understand there’s a lot of ways to handle emergencies. Most people are not going to a hospital purely for emergencies, because they can be handled by a qualified provider. We’re trying to encourage not just best practices of their current state, but also research into other things that affect our patients in emergency psychiatry moving forward.

Healio: Do you believe there are enough emergency psych providers, and is that one of the goals of the AAEP, to expand these services?

Thrasher: There are definitely not enough psychiatrists in general. There are definitely not enough emergency psychiatrists. Psychiatry is such an in-demand specialty, but a lot of people do not head toward the emergency domain.

We are — as part of the AAEP — looking to get people involved. It doesn’t mean it’s just one type of job — for someone who may need consults, there’s a telemedicine role. For other people it might be a community role, an empath unit or a crisis stabilization unit. There are many fascinating ways people can get involved with emergency psychiatry, either as a full-time career or to supplement their other offerings. As we grow the AAEP mission to bring people in, you won’t have to sacrifice what you’re doing to join the group.

Healio: What are some concrete ways that the AAEP can expand its reach, recruit and meet the needs of patients?

Thrasher: A lot of the work that we do as far as expanding both membership and mission is through education. This requires several different outreach opportunities at the conference level, grant work with other sister organizations like the American College of Emergency Physicians, and even doing some sort of grass roots stuff in our own area. A lot of our members are decision makers.

What you tend to see are concrete plans that either involve an immediate geographical area to develop new sites like a crisis organization, or on the national level spreading the word on how people can set these up. A lot of the AAEP is we’re not just doing it ourselves but teaching others how to do it in their own home area.

Healio: Do you see emergency psychiatry as a bridge between identifying mental health issues and the prevention of mass shootings?

Thrasher: What’s really important as we [discuss] this, is that there is a very small percentage of perpetrators of mass violence that are significantly mentally ill. It oscillates between 15% and 20%. It’s a group we are always looking to work with and take care of, but it’s a good reminder to the community at large that one of the reasons I think mass shootings continue to befuddle people, is they are focusing on the 15% or 20% and not the other 80%.

One of the hardest things we face, is making sure we take care of the group that is clearly mentally ill and yet not signing off or ignoring the other 80%. There’s something psychiatrists can bring to the table in terms of interviewing, assessment, risk stratification and mitigations. There are a lot of things we can do to help threat assessment teams and to train others.