What does a psychologist in the emergency department do?

Most psychologists in private practice work regular hours. But not Sherman K. Sloan, PhD, a founding partner of Emergent Care Psychologists, PA, in Pinellas Park, Florida. The five psychologists in his practice -- three full-time and two part-time -- may work after normal business hours, on weekends or holidays, when they assess people who have been involuntarily detained to determine whether they can be released. In her practice, Sloan also assists other patients in psychiatric, medical and rehabilitation hospitals, helping them cope with anxiety, depression and other problems.

The bulk of Sloan's work focuses on patients who have been forcibly admitted to a mental institution by emergency physicians, police officers, or even neighbors convinced that someone is dangerous.

"These patients may have attempted to harm themselves, overdose, or express suicidal thoughts while intoxicated," Sloan says, adding that many of these patients have substance use problems. He and his colleagues are conducting "lethality" assessments to determine whether it's safe to release patients to a less restrictive level of care, as well as assessing patients' desires and their ability to make their own decisions when developing alternative treatment plans.

Although Sloan does not usually maintain an ongoing relationship with patients, he says, "Obviously, we want to do the assessment in a therapeutic manner." For patients with substance use problems, this may mean conducting a motivational interview, helping them develop a plan to stay clean, and referring them to community organizations for further help.

Sloan began working in acute care early in his career. After receiving his doctorate in clinical psychology from the Illinois School of Professional Psychology in 1986, he spent nearly a decade at Magellan Behavioral Health in Tampa. Eventually, he became a regional crisis director responsible for evaluating and treating patients whose psychiatric and substance use problems put them at risk of hospitalization.

In 1998, Sloan and his partner Emily J. Futch, PhD, founded Emergent Care Psychologists. The practice now contracts with a half-dozen hospitals to provide care to all patients with psychological problems in exchange for payment per patient or on a surrender basis.

"As far as I know, we're the only group of psychologists in the private sector that contracts with medical hospitals to provide psychological counseling," Sloan says, adding that most local psychiatrists choose not to work with hospital patients because many of them are either on Medicaid or have no insurance at all.

What's in it for the hospitals? Lower costs and better care, Sloan says. Take suicidal patients. Suicidal gesture patients usually end up in intensive care units or in beds with 24-hour "caregivers" - both of which are extremely expensive. Bringing in psychologists to provide emergency care is not only cheaper. Addressing patients' psychological needs also reduces what Sloan calls "noise" in the wards -- the agitation, combative and other behaviors that prevent nurses and other staff from doing their jobs and other patients from resting and recovering.

Sloan, Futch and their colleagues also address issues such as anxiety, depression or grief in hospitalized patients. For example, an ICU physician might ask for advice on how to help a patient who panics every time a doctor tries to disconnect him or her from a ventilator. Sloan can teach the patient breathing techniques or provide cognitive-behavioral interventions to reduce their anxiety.

And while Florida psychologists cannot order, prescribe or dispense medication, Sloan also advises doctors and other professionals on prescribing psychotropic drugs.

"It could be a patient who has taken psychiatric medications in the past, and the physician would like a mental health professional to analyze those medications and see if the patient needs to go back on them or continue taking them," says Sloan, who is board certified in psychopharmacology. "We have some authority to recommend medications to attending physicians, neurologists or other physicians who work with patients."

Regardless of the problem, the process begins when a physician calls the practice dispatch line and asks for a consultation. During the evaluation, psychologists work with emergency department physicians, trauma surgeons, neurologists, infectious disease specialists, and other physicians, as well as nurses, nurse trauma practitioners, case managers, and family members. There are also many informal conversations with other specialists in the general "recorder rooms" where physicians and other specialists write their consultation reports.

Working with hospitalized patients can be challenging, Sloan admits. First, most of his patients are in crisis.

"Sometimes we see patients who jumped off the Sunshine Skyway Bridge - the highest in the region - and survived, or patients who shot themselves or stabbed themselves," he says.

He and his colleagues must also have the confidence to make decisions about the release of involuntarily hospitalized patients, with all the potential liabilities that entails. In addition, they must be willing to work very long hours, if necessary.

But such work represents a large potential growth area for psychologists who can handle such workloads, says Sloan, who hopes to expand his practice.

"We've been short-handed," he says, adding that hiring new psychologists could allow the practice to do more psychological and behavioral interventions with patients. "Right now we don't have the time to do as much as we'd like."