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In the United States, Psychiatric Emergency Services facilities are a type of acute psychiatric facility that is available for mental health emergencies. They are generally open 24 hours a day. In the United States, each large county has one. Mental health for the indigent in the United States is is divided by counties, after the passage of a federal Community Mental Health Law in 1963.
Most large counties have established a PES, or similarly named facility to handle emergency cases. The staff of an emergency psychiatry unit may consist of Psychiatrists (MD), Registered Nurses (RN), Psychologists (PhD), Social Workers (CSW), Psychiatric Technicians, and clerical staff. These units are often the entryway into the mental health system for the most severely ill patients. PES helps coordinate care for the most severely ill in a county. It is a specific place for emergency care. A PES clinic may be located within a general medical hospital, with a psychiatric hosptial, or free-standing.
Patients arrive in several ways: by the police, sent from other emergency rooms, from outpatient clinics, from physician's offices, brought in by family or friends and self presentation. PES clinics are often locked due to the nature of the patients. Not all patients are involuntary, but may are. Mental health laws vary from state to state, but people can generally only be held against their will for being a danger to themselves, danger to others or the inability to provide food, clothing and shelter for themselves. Mental health have become more liberal in the past 30 years in the United States. Simply having a mental illness is almost never grounds for detaining someone. The must meet of the above criteria.
In the past chronically ill patients were comitted to state hospitals, often for years. In the 1970s-1980s many state hospitals were closed in a process call deinstitutionalization. It was largely considered unsucessful as there were no suitable place for the patients to go. This has lead to a increase in the homeless population. Many patients that are seen frequently in a PES, would have been comitted to a state hospital in the past.
Typical emergencies include suicidal thoughts, psychosis and drug intoxication. These are not specific diagnoses, but patients aften fall into one of these categories.
Often patients can stay in an emergency psychiatric facility for up to 24 hours. After which they are several possiblities. Patients may be admitted to an in-patient psychiatric unit. They may be transfered to a medical unit, if have an underlying, non-psychiatric, general medical problem. Patients may be discharged home, with a friend, to a unlocked facility in the community or to a shelter.
Other names for these facilities include: