Why EMPATH Units Are Changing Behavioral Health in the Emergency Department
Behavioral health crises have become one of the most visible and most challenging pressure points in hospitals across the country. Emergency departments are increasingly overwhelmed by patients in psychiatric crisis, many of whom wait hours or even days for care while boarding on gurneys behind curtains. The prevailing narrative suggests this is a psychiatric bed shortage problem. But according to Dr. Scott Zeller, that framing misses the real issue.
In a recent episode of The Architecture of Healing, Dr. Zeller, one of the nation’s leading voices in emergency psychiatry shares why psychiatric boarding is fundamentally a care model and an environmental problem, and how EMPATH units are offering a proven alternative.
From Chaos to Clarity on the Front Lines
Dr. Zeller’s perspective is grounded in decades of frontline experience. As Medical Director of Psychiatric Emergency Services in Alameda County, California, he oversaw one of the busiest psychiatric emergency systems in the country, often treating 50 to 60 involuntary patients a day in a space designed for far fewer.
Despite overcrowding and limited resources, something unexpected kept happening: patients calmed down. Violence was rare. Most individuals stabilized quickly and were able to go home rather than being admitted. That contradiction sparked a critical question: If this works in the most constrained, stressful conditions, what could happen if we intentionally designed a space for crisis care?
That question became the foundation for what is now known as the EMPATH Unit, short for Emergency Psychiatric Assessment, Treatment, and Healing.
What Is an EMPATH Unit?
An EMPATH unit is a dedicated space often adjacent to or connected to the emergency department, specifically designed to care for patients experiencing behavioral health emergencies. Unlike traditional ED psychiatric rooms, EMPATH units replace isolation and restraint with openness, visibility, and comfort.
Patients are treated quickly by psychiatric clinicians, seated in recliners instead of gurneys, and given access to basic needs like food, water, movement, and human interaction. The goal is rapid stabilization, not prolonged containment.
The results are striking. Across multiple sites, data shows that 75–80% of patients initially thought to require inpatient psychiatric admission stabilize within 24 hours and can safely return home. This single outcome challenges decades of assumptions about crisis care.
Why Environment Matters More Than We Think
One of the most powerful insights from the conversation is that the physical environment is not neutral, it actively shapes behavior, safety, and outcomes.
Traditional emergency departments are optimized for trauma, cardiac events, and medical emergencies. For someone in psychiatric crisis, those same environments can feel chaotic, punitive, and frightening, escalating agitation rather than resolving it.
EMPATH units leverage principles of therapeutic milieu and trauma-informed design. Open spaces reduce fear. Visibility increases safety. Social interaction helps restore a sense of normalcy and hope. In many cases, simply removing the adversarial feel of the ED dramatically changes how patients present clinically.
As Dr. Zeller explains, people in crisis often look very different once they are moved into the right environment, sometimes within minutes.
Operational and Financial Impacts
Beyond patient outcomes, EMPATH units offer compelling operational benefits. Psychiatric boarding ties up ED beds, requires sitters or security staff, increases burnout, and slows throughput for all patients. By moving behavioral health patients into a dedicated care pathway, hospitals free up emergency capacity while delivering more appropriate care.
Financially, this model also makes sense. Psychiatric boarding is largely non-reimbursable. EMPATH units, by contrast, deliver billable, active treatment. Many units are created by repurposing underutilized space, often for a fraction of the cost of new inpatient facilities or large off-site crisis centers.
Dr. Zeller emphasizes a key comparison: hospitals may spend $1–5 million to build an EMPATH unit, while alternative crisis strategies can cost $50–200 million, and still fail to divert patients from the ED.
Scalability Across Communities
Another common misconception is that EMPATH units only work in large urban hospitals. In reality, the model scales easily. Units range from as small as four chairs in rural hospitals to more than 60 chairs in major medical centers.
Because behavioral health emergencies exist everywhere and because EMTALA requires hospitals to treat them, every community can benefit from a better approach at the point of entry.
A Shift in How We Think About Crisis
Perhaps the most profound takeaway from the episode is philosophical. Crisis care doesn’t fail because patients are too complex. It fails when systems are designed around avoidance, delay, and containment rather than treatment, dignity, and healing.
EMPATH units represent a shift from asking “Where can we send this patient?” to “How can we help this person right now?”
As healthcare leaders grapple with rising behavioral health demand, staff burnout, and operational strain, EMPATH units offer something rare: an evidence-based solution that improves outcomes for patients, clinicians, and the system as a whole.
Sometimes, innovation isn’t about inventing something new, it’s about finally aligning care, space, and purpose around what works.
