Crisis Management and Care Planning in Schizophrenia

In "Crisis Management and Care Planning in Schizophrenia," our panel explores the complex and high-stakes process of managing acute psychiatric crises, tracing the care pathway from initial emergency presentation through crisis planning in outpatient settings.

Dr. John Kane opens by walking through the challenges of evaluating a patient who arrives at the emergency department with no history, no records, and no medication list. He emphasizes that thorough evaluation is paramount, and that hospitalization is sometimes necessary simply to gather sufficient information to guide care. He outlines the key decision points clinicians face — including whether the patient poses a danger to themselves or others, what social supports are available, and whether a less restrictive setting such as a day program or outpatient clinic could be appropriate. Dr. Kane highlights the often overlooked potential of long-acting injectable medications as an acute intervention in the emergency setting, suggesting that for patients with adequate social support who are not an immediate danger, an emergency department injection could potentially prevent hospitalization altogether — a cost-effective and clinically meaningful strategy he would like to see explored more formally. He also cautions against premature diagnostic closure, noting that substance use frequently complicates the differential and that diagnosis should be understood as an iterative process.

Dr. Hara Oyedeji then addresses the proactive side of crisis management, emphasizing the importance of developing structured crisis plans in collaboration with patients and caregivers before an emergency arises. She stresses that safety must be the guiding priority, and outlines the essential components of an effective crisis plan: identifying the nearest hospital and crisis walk-in center, ensuring caregivers know which numbers to call, maintaining open communication across the care team, and documenting the plan thoroughly. She acknowledges that patients may avoid calling emergency services due to prior trauma or fear, and underscores the clinician's responsibility to address this directly, ensure all options are discussed, and protect both the patient and themselves through clear documentation and planning.

Our next episode, "Optimizing Care Transitions and Access in Schizophrenia Management," examines the practical dimensions of schizophrenia care delivery, including the opportunities and limitations of telemedicine, the case for initiating long-acting injectables during inpatient stays, and the underutilized resources — from drug sampling and patient assistance programs to prior authorization — that can help bridge the gap between treatment decisions and medication access.