​​The Toronto Western Hospital Psychiatric Emergency Services Unit (PESU) team
The Toronto Western Hospital Psychiatric Emergency Services Unit (PESU) team is dedicated to providing care to patients in distress. (Photo: UHN)

There is a sense of calm in the Psychiatric Emergency Services Unit (PESU) – a specialized area of the TWH emergency department with trained mental health experts to help patients in crisis. Staff move seamlessly in the small space that overlooks patients from behind a safety glass. Angelina Medjed, a PESU nurse, is preparing to discharge a patient and will ensure they are connected with the support they need in the community before they leave.

"We are working with patients who are in an acute state of crisis and what they need is compassion and a team that provides care in a non-judgmental way," said Medjed. 

With a capacity of four beds and four ambulatory spaces, PESU takes up a small corner on the first floor of Toronto Western Hospital off of the emergency department.

"A lot of people don't know about us," said Aideen Carroll, APN. "But we're actually the largest mental health provider attached to an acute care hospital and we're open 24-hours a day, seven days a week."

Despite being small in physical size, the PESU team hopes to have a big impact on its patients. Their latest initiative is the PESU Recovery Empowerment Card.

The Recovery Empowerment Card is a blue, pocket-sized card that patients are given once they've been discharged from PESU. It contains a list of important resources and phone numbers, like the Crisis/Distress Line, Food Bank, and Shelters Central Line, to give patients an easily accessible tool when they're experiencing a stressful situation.

The Recovery Empowerment Card also provides space for patients to list phone numbers of family, friends, a family physician, or case worker. This makes it easy for the patient to use, but also helps the PESU staff determine who to notify if the individual returns to the unit. A section for patient's to list their preferred coping techniques is available to assist both the patient and staff with managing a crisis.

"The Empowerment Card helps make the patient aware of what works for them when they're having trouble coping in a crisis," said Medjed. "It also breaks up important information into simple sections and this helps them achieve more and gives some independence."

PESU manages patients with:

  • Anxiety disorders (i.e. panic disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder)
  • Eating disorders
  • Mood disorders (i.e. major depressive disorder, bipolar disorder)
  • Cognitive disorders (i.e. delirium, dementia (secondary to general medical condition), dementia associated with alcoholism, dementia of the Alzheimer type, dementia)
  • Personality disorders
  • Schizophrenia and other psychotic disorders
  • Substance related disorders (i.e. alcohol, amphetamine, cannabis, cocaine, or nicotine dependencies)
  • Patients who are violent, suicidal, or homicidal

The average length of stay for patients in the PESU is usually less than 48 hours, so the team of nurses, psychiatric assistants, clinicians and staff psychiatrists believes the card can give patients the confidence to manage difficult situations when they leave the unit.

"Not only does the card allow patients to go away with something tangible​, it also enforces our belief that each individual has a unique set of strengths and abilities he or she can rely on to overcome problems," said Nanette Lang, Manager of PESU.

"We work from a strength-based recovery model and the empowerment card is reflective of that philosophy."

The card also supports UHN's guiding philosophy of Partners in Care and making sure patients are involved in actions and decisions, Carroll said.

"The strategies come from the patient, from their heart," Medjed adds.

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