Are EDs the Only Option? Hospital-Based Alternatives to the Emergency Department for Mental Health Crises: A Scoping Review.

This is a scoping review, not a controlled comparison of crisis services with emergency departments, so it cannot show that any service works better. The included sources varied in design and nature, and service descriptions were inconsistent. Only some services had evaluations, and those evaluations used different methods and outcomes, so comparison is difficult. Several important domains were least evaluated, including involuntary holds, restraint use, staff workload, capacity and cost. Some services were used beyond their intended purpose, such as managing acute ward overcrowding or admitting adolescents outside guidelines. It is likely additional crisis services exist but were not described sufficiently to be included.

The authors declare no conflicts of interest.

Do not conclude that hospital-based alternatives are proven better than emergency departments. The review summarised descriptive service reports and heterogeneous evaluations, not controlled comparisons, and the authors state that current evidence is fragmented and insufficient to establish effectiveness.