Teaching Clinical Psychiatry in the Emergency Room: Is There a Room for Competency-Based Medical Education?

Abstract

Sir, The recent release of the World Mental Health report by the World Health Organization has again highlighted the grim picture of global mental health. According to the report, one billion of the world’s population suffers from mental disorders, and the treatment gap remains disparagingly high at more than 70% in Lowand Middle-Income Countries (LMICs). The report has urged the LMICs to develop community services and integrate mental health services with existing general medical setups to bridge unmet mental healthcare needs (Cuijpers et al., 2023). Defined by the American Psychiatric Association as “an acute disturbance in thought, mood, behaviour or social relationship, as defined by the patient, the family, or the social unit,” psychiatric emergency requires immediate intervention (Sood & Mcstay, 2009). Psychiatric emergencies in the Emergency Rooms (ER) include a suicide attempt, self-harm, aggression, acute psychosis, delirium, substance abuse or withdrawal. These crises provide a valuable opportunity for the resident to view the interface between medicine and psychiatry (Bruffaerts et al., 2008; McPherson, 1984). The sheer emergent nature of the clinical encounter demands selective assessment and multimodal management, which often involves psychological, familial, and social support and pharmacological interventions. Environmental modifications and psychological therapies in managing delirium and suicidality demonstrate the importance of these elements in the biopsycho-social approach of psychiatric management (Rusk, 1971). Medical disorders presenting as psychiatric crises and psychiatric disorders presenting with medical co-morbidities in the ER highlight the biomedical underpinnings of psychiatry. A comprehensive medical and psychiatric assessment carried out by a multidisciplinary team provides a unique mutual learning opportunity of immense value for medicine and psychiatry residents. With time, the psychiatry resident becomes an expert in assessing volatile affective states, providing crisis interventions, and being valued as an indispensable part of the multidisciplinary team. The structured clinical psychiatry teaching in the ER has immense value in integrating it with general medical settings. ER can be used as a setting for training ER physicians on the interface of psychological and physical impacts of disasters and calamities. The integration of mental health assessments and interventions, when routinely addressed during ER training, has the potential to identify individuals in need of psychological services, promote resilience, improve psychological interventions being