Mental health in America — why there is no real treatment

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Mental health in America — why there is no real treatment

Can you imagine waiting in an emergency department for days for a hospital bed? What if your parent, significant other or child experienced something like this?  This is the awful reality for many of our most vulnerable patients — our psychiatric emergency patients.

We don’t know what the exact clinical outcomes are for psychiatric patients who are forced to languish in our emergency department's waiting for an in-patient bed. But as doctors, we know the experience isn’t good for them. And when you have nowhere else to turn, it becomes the only option for care.

The nation’s dwindling mental health resources are having a direct impact on patients with psychiatric emergencies, including children. These patients wait longer for care, especially those who require hospitalization. The severe shortage of psychiatric beds in almost all hospitals and lack of intensive outpatient resources is leaving these patients stranded for hours and even days in our emergency departments. We have to do better.

Three-quarters of emergency physicians responding to a recent poll by the American College of Emergency Physicians (ACEP) reported seeing patients every shift who require hospitalization for psychiatric treatment. That certainly tracks with my experience.

The problem is that once the decision to admit a patient has been made, it can be nearly impossible to find an in-patient bed for them. Almost half of emergency physicians in this poll say they have psychiatric patients waiting for an in-patient bed one or more times per day.  All of those patients require care and monitoring while they are in the emergency department. his keeps our physicians and nurses from treating new patients who come through the door. The ripple effect is real.

A recent study in Annals of Emergency Medicine by Suzanne Lippert, MD, MS, FACEP, an emergency physician from Stanford University, found that 23 percent of patients having psychiatric emergencies stayed in the emergency department more than 6 hours, whereas only 10 percent of medical emergency patients stayed that long. They were also more likely than medical emergency patients to be transferred to another facility. The reason is simple: lack of resources.

Virtually every emergency physician I know can report about the surge in psychiatric patients filling their emergency departments over the last year. These patients have needs that are simply not being met anywhere else so they come – or are brought – to the only place that does not turn anyone away: the emergency department.  

The cutbacks to mental health services that more than half of our members have witnessed in their communities over the last year are exerting extreme pressure on emergency departments. Our ERs have become the dumping ground for these patients who have been abandoned by every other part of the health care system.    

ACEP has long supported meaningful mental health reform Our recent research makes it clear that it is time to deliver on the promises made by members of Congress to enact comprehensive mental health reform. A good start would be for the Senate to follow the example set by the House in approving bi-partisan legislation (“Helping Families in Mental Health Crisis Act of 2016”) to begin to address the inadequacies in the mental health system in the United States. But I am reluctant to use the terms “mental health system” because there really isn’t one.  For decades, resources have been diverted away from inpatient and outpatient services for people with serious mental illness.  It is time to reverse that trend.

Dr. Rebecca Parker is president of the American College of Emergency Physicians and a practicing emergency physician in Park Ridge, Illinois.