Mentally ill flood ER as states cut services 

By Julie Steenhuysen and Jilian Mincer 
Reuters
December 24, 2011

 http://news.yahoo.com/mentally-ill-flood-er-states-cut-services-131133880.html

CHICAGO/NEW YORK (Reuters) - On a recent shift at a Chicago
emergency department, Dr. William Sullivan treated a newly
homeless patient who was threatening to kill himself.

 "He had been homeless for about two weeks. He hadn't
 showered or eaten a lot. He asked if we had a meal tray,"
 said Sullivan, a physician at the University of Illinois
 Medical Center at Chicago and a past president of the
 Illinois College of Emergency Physicians.

 Sullivan said the man kept repeating that he wanted to kill
 himself. "It seemed almost as if he was interested in being
 admitted."

 Across the country, doctors like Sullivan are facing a spike
 in psychiatric emergencies - attempted suicide, severe
 depression, psychosis - as states slash mental health
 services and the country's worst economic crisis since the
 Great Depression takes its toll.

 This trend is taxing emergency rooms already overburdened by
 uninsured patients who wait until ailments become acute
 before seeking treatment.

 "These are people without a previous psychiatric history who
 are coming in and telling us they've lost their jobs,
 they've lost sometimes their homes, they can't provide for
 their families, and they are becoming severely depressed,"
 said Dr. Felicia Smith, director of the acute psychiatric
 service at Massachusetts General Hospital in Boston.

 Increased demand in mental health services

 http://link.reuters.com/sud75s

 State mental health budget cuts

 http://link.reuters.com/tud75s

 Visits to the hospital's psychiatric emergency department
 have climbed 20 percent in the past three years.

 "We've seen actually more very serious suicide attempts in
 that population than we had in the past as well," she said.

 Compounding the problem are patients with chronic mental
 illness who have been hurt by a squeeze on mental health
 services and find themselves with nowhere to go.

 On top of that, doctors are seeing some cases where the
 patient's most critical need is a warm bed.

 "The more I see these patients, the more I realize that if
 it's sleeting and raining outside, the emergency room is the
 only place they have," said Dr. R. Corey Waller, director of
 the Spectrum Health Medical Group Center for Integrative
 Medicine in Grand Rapids, Michigan.

 Government agencies such as the National Institutes of
 Mental Health, the Centers for Disease Control and
 Prevention and the Substance Abuse and Mental Health
 Services Administration could not provide fresh data on use
 of psychiatric services in recent years.

 But doctors from more than a dozen hospitals nationwide,
 mental health advocacy groups and state-funded agencies told
 Reuters they are all seeing a marked increase in psychiatric
 emergencies.

 A WORSENING PROBLEM

 The National Association of State Mental Health Program
 Directors (NASMHPD), an organization of state mental health
 directors, estimates that in the last three years states
 have cut $3.4 billion in mental health services, while an
 additional 400,000 people sought help at public mental
 health facilities.

 In that same time frame, demand for community-based services
 climbed 56 percent, and demand for emergency room, state
 hospital and emergency psychiatric care climbed 18 percent,
 the organization said.

 "This wasn't one round of cuts," says Ted Lutterman,
 director of research analysis at NASMHPD Research Institute.
 "It was three or four for many states, and multiple cuts
 during the year."

 If the economy doesn't improve, next year could be worse
 because many community mental health agencies are cutting
 programs and using up reserve funds, says Linda Rosenberg,
 president of the National Council for Community Behavioral
 Healthcare.

 "It's been horrible," she said. "Those that need it the most
 - the unemployed, those with tremendous family stress - have
 no insurance."

 In the emergency room, this increased demand has meant
 doctors and social workers are spending hours and sometimes
 days trying to arrange care for psychiatric patients
 languishing in the emergency department, taking up beds that
 could be used for traditional types of trauma.

 More than 70 percent of emergency department administrators
 said they have kept patients waiting in the emergency
 department for 24 hours, according to a 2010 survey of 600
 hospital emergency department administrators by the
 Schumacher Group, which manages emergency departments across
 the country.

 Ten percent said they had "boarded" patients for a week or
 more.

 And many hospitals are not prepared for the increased
 caseload of psychiatric patients, says Randall Hagar,
 director of government affairs for the California
 Psychiatric Association.

 California cut $587 million in state-funded mental health
 services in the past two years, the most of any state,
 according to the National Alliance on Mental Illness, a
 patient advocacy group.

 "They don't have secure holding rooms. They don't have quiet
 spaces. They don't have a lot of things you need to help
 calm down a person in an acute psychiatric crisis," Hagar
 said.

 "Often you have a patient strapped to a gurney in a hallway
 outside of the emergency department where social workers are
 desperately trying to find an inpatient bed," he said.

 FROM CITIES TO SMALL TOWNS

 In North Carolina, the state has cut its inpatient
 psychiatric capacity by half since 2005, says Dr. Bret
 Nicks, an emergency physician at Wake Forest Baptist Medical
 Center in Winston-Salem and a spokesman for the American
 College of Emergency Physicians.

 Nicks points to a report from the Institute of Medicine
 released in 2006 that found U.S. emergency departments were
 already overtaxed and overcrowded.

 "Now you are adding in patients who are unsafe to leave but
 yet have nowhere to go," he said. "I consider patients with
 acute psychiatric needs as really the forgotten patient
 population in the U.S. right now."

 Dr. Stephen Anderson is an emergency department doctor at
 Auburn Regional Medical Center, a mid-size suburban hospital
 outside of Seattle.

 "When the economy is hurt they are some of the first to drop
 off the healthcare rolls," he said of local residents in the
 largely blue-collar community.

 Anderson, who heads the Washington Chapter of the American
 College of Emergency Physicians, said the state has lost a
 third of its inpatient psychiatric beds in the past decade.

 Lately he is seeing a marked escalation in patients with
 psychiatric problems turning up in the emergency department.
 In early December, a third of its beds were occupied with
 people in a psychiatric crisis who were not safe to return
 to the community.

 The problem extends out to small towns.

 Sullivan splits his time between the big emergency
 department at the University of Illinois Medical Center at
 Chicago and St. Margaret's Hospital, a tiny facility in
 Spring Valley, Illinois, about 100 miles southwest of the
 city.

 On a recent shift, a young woman with schizophrenia arrived
 at the hospital. She had just lost her job and apartment and
 was living with relatives. She could not afford the
 medications that were keeping her illness in check.

 The woman asked Sullivan to switch her prescriptions to
 drugs that could be found on the $4 discount list at Wal-
 Mart and other discount stores.

 "I didn't feel comfortable doing that," Sullivan said,
 noting that emergency physicians are being asked to deliver
 specialized care that should be handled by a psychiatrist.

 He found a healthcare facility about 25 miles away with a
 psychiatrist who could help, but even that presented a
 problem for the woman, who had no way of getting to the
 appointment.

 "It's almost akin to having a cardiac patient come in and
 say, 'I need someone to adjust my defibrillator.' In the
 emergency department, we can do a lot, but there are some
 things we have to leave with the specialists," he said.

 (Editing by Michele Gershberg and Eric Beech)

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