Treating Mental Illness in the ER

Identifying traits that impact care for patients with mental illness.

In the American healthcare system, no one transcends the potential for holding preconceived attitudes-not even those who provide the healthcare.

Jennifer McIntosh, PhD '21, MS '24, adjunct professor in the Adelphi University College of Nursing and Public Health, is particularly concerned about the stigma experienced by patients with mental illness. As a nurse, educator and community advocate herself, Dr. McIntosh knows firsthand that emergency room care is some of the most demanding work available to healthcare professionals. And while emergency nurses are well prepared to care for patients with medical crises, Dr. McIntosh notes that the interventions used for patients with mental health emergencies are far less safe, thorough and empathetic.

"The reality is, with one in five people living with a diagnosis of mental illness nationwide, regardless of where a nurse chooses to work, they will encounter a patient, caregiver or co-worker living with a mental health disorder," she said. "Therefore, it is critical for nurses to receive training in approaches to delivering person-centered care to individuals with mental illness, as the emergency department is often the entry point to healthcare."

Along with her colleague and dissertation adviser, William Jacobowitz, EdD, professor in the College of Nursing and Public Health, Dr. McIntosh co-authored "Attitudes of Emergency Nurses Toward Clients With Mental Illness: A Descriptive Correlational Study in a Nationwide U.S. Sample" (Issues in Mental Health Nursing, January 2024).¹ The study, which pulls from extensive national data, was the first of its kind to compare emergency nurses' characteristics with their negative perceptions of mental illness.

Drs. McIntosh and Jacobowitz considered multiple factors in an effort to identify personal and professional attributes that were linked to lower levels of stigma, including attributes related to education and on-the-job support. Their data analysis revealed that nurses with previous training and work experience with psychiatric service, as well as those who had continuing access to in-service training for communication skills, sensitivity, empathy and suicide assessment, were far less likely to express stigma about people with mental illness. Additionally, participants with associate degrees in nursing reported significantly lower stigmatizing attitudes than those with other degrees, including a bachelor's degree.

These findings have important implications for nursing education. Integrating more mental health content throughout a program's curricula, instead of offering a single course, could significantly improve how patients with mental illness are treated by frontline nursing staff.

In their study, Drs. McIntosh and Jacobowitz also considered participants' "nonmodifiables," such as age, gender, race/ethnicity, marital status and shifts worked. They found that certain attributes of emergency room nurses were significantly associated with lower levels of stigma. Three demographics generally held lower rates of stigma toward mental illnesses: married female nurses, night shift nurses and nurses who identified as non-Hispanic.

While there are certainly deeper, more complex reasons for these results, the authors suggest that emergency departments can begin tackling the problem of stigmatization simply by fostering cultures of acknowledgment. In other words, nurses' varying attributes and backgrounds will impact their feelings on mental illness and should be addressed accordingly. Emergency department leaders should look to implement educational and training interventions that target the specific needs of their staff. These efforts will not only cut down on bias, but ultimately improve the health outcomes of individuals with mental illness. In Dr. McIntosh's view, the nursing profession can best reduce stigma by recognizing mental illness as an illness like any other-and "by treating people, all people, including people with mental illness, with care, compassion and respect."

Read more in the 2025 issue of Academic & Creative Research Magazine, where we highlight the innovation and imagination shaping Adelphi's academic community.

1 McIntosh, J. T., & Jacobowitz, W. (2024). Attitudes of emergency nurses toward clients with mental illness: A descriptive correlational study in a nationwide U.S. sample. Issues in Mental Health Nursing, 45(1), 105-113. https://doi.org/10.1080/01612840.2023.2278773

About Our Faculty

Jennifer McIntosh, PhD '21, MS '24, is an adjunct professor in the College of Nursing and Public Health as well as a senior lecturer at Yale School of Nursing. A former emergency nurse, Dr. McIntosh's recent research has focused on emergency nurses' perceptions of attribution and individualized care toward people with mental illness and on "VIP care": providing enhanced care to people deemed more important than others, and the clinical and ethical implications of that for nurses and care recipients.

William Jacobowitz, EdD, is a professor in the College of Nursing and Public Health whose research interests include mental health nursing and post-traumatic stress disorder. He has more than 25 years' experience in senior leadership positions at psychiatric facilities throughout New York.