WASHINGTON — Appearing before Congress on Wednesday morning, Dr. Jon Mark Hirshon, an emergency physician from Maryland, called on representatives to increase resources for psychiatric care in the United States, saying there has been a dramatic rise in emergency patients with chronic psychiatric conditions, and these patients often waits days in the emergency department until psychiatric beds become available.
Dr. Hirshon, who served as the Task Force Chair for the 2014 ACEP Report Card on America’s Emergency Care Environment, testified before the House Committee on Energy and Commerce Subcommittee on Oversight and Investigations, which is chaired by Rep. Tim Murphy (R-PA).
“The health care system is failing to address the needs of patients with chronic psychiatric conditions,” said Dr. Hirshon. “Until more funding and services are made available, emergency departments will continue to serve as a safety set for them” said Dr. Hirshon.
According to Dr. Hirshon, solutions include:
- Increased hospital inpatient staffing and capacity . Additional psychiatric inpatient beds would help to alleviate boarding for those patients who require hospital-level care.
- Better case management of patients to decrease psychiatric emergencies.
- Increased Outpatient Capacity/Community Alternatives. Two specific community services that have shown promise as part of system-wide improvements of mental health services were crisis residential services and mobile crisis teams. Crisis residential settings could care for patients who do not need to be in a hospital setting, allowing the ED to see more acute medical patients. Mobile crisis, often referred to as diversion teams, provide crisis intervention and stabilization services to psychiatric patients in the community, preventing many patients from seeking care in the ED.
- Innovative Psychiatry (Tele-Psychiatry & Psychiatrists as Hospitalists). Use of tele-medicine would allow psychiatrists to perform evaluations and screenings of psychiatric patients when they cannot be physically present in the ED. This may alleviate inappropriate inpatient admission, and thus, lead to reduced boarding.
- Eliminate Out-of-Network Insurance Issues. Hospitals that have available psychiatric beds are not always authorized to accept patients if these hospitals are not in the patients' insurance network. Eliminating the in-network requirement would increase available options for inpatient care.
Others providing testimony at the hearing included Lisa Ashley, the mother of a child with severe mental illness, Dr. Jeffery Geller with the University of Massachusetts, Chief Michael Biasotti with the New Windsor, NY police department and Sheriff Thomas Dart with the Cook County Sheriff’s Office in Chicago.
For many patients with psychiatric conditions they have no other options but to go to the emergency department. Often, these patients will wait, or are “boarded” for several hours, sometimes even days, until an inpatient bed becomes available or a proper facility can be found. This increases stress on emergency departments which are already overwhelmed with patients, and can cause patients to be harmful to themselves, other patients and staff. A 2008 ACEP survey found that 99 percent of emergency physicians reported admitting psychiatric patients daily.
Dr. Hirshon said that until more services and funding are made available to address this national crisis, emergency departments will continue to be the safety-net for those patients.
“Necessary resources must be made available for additional inpatient and outpatient treatment beds, more professional staff, and critically needed research,” said Dr. Hirshon. “Otherwise, mental health services will continue to deteriorate, and these people, often our family members — will continue to be at risk for abuse and neglect — seeking care in our emergency departments for lack of any other support.”
Dr. Hirshon’s testimony and the complete subcommittee hearing can be found at https://energycommerce.house.gov/hearing/where-have-all-patients-gone-examining-psychiatric-bed-shortage
ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.