The Alameda Model: An Effort Worth Emulating

Because the mental health care system in California is fragmented and chronically under-funded, the burden of psychiatric care has predictably fallen on emergency physicians. Community mental health resources and funding have decreased steadily over recent years, with the number of acute inpatient psychiatric beds per capita decreasing by over 30% since 1995.1 In 1995, there were over 9,000 acute inpatient psychiatric beds, only to decrease each year to just 6,367 beds statewide in 2011.1,2 In addition, 25 of California’s 58 counties have no adult beds, and 45 have no pediatric beds, largely affecting rural counties and making post-discharge care nearly impossible – all while the number of acute psychiatric discharge diagnosis has been steadily increasing since 2007.2 As a result, the struggle to find resources to care for this challenging patient population has become all too familiar to most emergency physicians. The “Alameda Model” described by Zeller et al3 is an example of a regional solution to the increasing problem of mental health patients boarding in emergency departments (ED). Zeller et al3 provides an answer to the ubiquitous question in emergency medicine...Where is this patient going? Too often for our mental health patients the answer is nowhere fast. Alameda County has established a dedicated psychiatric hospital with an accompanying crisis stabilization unit. The regionalization of psychiatric care in Alameda allows expedited transfers from local EDs to the psychiatric hospital. The authors report an average time to transfer of 1 hour 48 minutes after completion of medical clearance. This is a considerable achievement, in comparison to the 6 to 16 hours noted in Stone et al.4 In addition, Alameda’s dedicated psychiatric hospital also accepts patients directly from EMS without an initial evaluation in an ED, which the authors note is a majority (60%) of their patient population. It would be interesting to know how many of the patients discharged in less than 23 hours were transferred from local EDs versus direct admissions from the field. Furthermore, John George Hospital, Alameda’s dedicated psychiatric hospital, meets its EMTALA obligation by accepting all transfers for emergency stabilization of the acute University of California Davis Health System, Department of Emergency Medicine, Sacramento, California