[NYAPRS Enews] Stefan Globe Op Ed: ERs Wrong Place for Mental-Health Care

[Harvey Rosenthal]

Wrong Place for Mental-Health Care

By Susan Stefan   Boston Globe Op-Ed   November 7, 2007 

 

HOSPITAL emergency departments are among the least appropriate and most
expensive places in Massachusetts for patients in psychiatric crisis.
Yet these departments are where police, families, group homes, nursing
homes, and others routinely take people who are agitated, panicked, or
threatening to hurt themselves. Emergency departments are also where
people go at the end of the month when their medications run out, when
their primary physicians can't see them for two weeks, when they are
frightened or desperate and have nowhere to turn after 5 p.m. and their
therapist's answering machine tells them to go to the emergency room.

 

Emergency departments and these patients in crisis are both victims of a
healthcare system that increasingly relies on emergency care to cover
gaps in basic mental health and social services. Once at the emergency
department, psychiatric patients wait twice as long for help as other
patients, often in escalating frustration. Their interactions with
harried staff, who often have little mental-health training and resent
the long-term occupation of emergency beds, can make matters worse.
Emergency departments don't have much time to provide reassurance, and
often resort to restraint and seclusion - sometimes even handcuffs and
pepper spray. Many psychiatric patients recount harrowing and traumatic
experiences: As the Globe reported this summer, psychiatric patients
sometimes die and have bones broken in emergency departments. They are
often stripped of clothing and left for hours.

 

This has to stop, for all our sakes: the emergency departments, people
with psychiatric disabilities, and taxpayers who pick up the tab.

 

This problem isn't restricted to Massachusetts. Recently, Rhode Island's
mental-health advocate sued the state, arguing that involuntary
detention in nontherapeutic emergency rooms for days without treatment
violated state constitutional and statutory obligations. A few months
earlier, advocates in New York filed a far-reaching lawsuit to end
emergency department overcrowding and mistreatment at King's County
Hospital Center.

 

In Massachusetts, advocates and patients have sought help from the
Legislature. In September, Massachusetts lawmakers heard witnesses tell
horror stories of their experiences in emergency departments, sometimes
after going there just for medical care. Bills filed by Representatives
Ruth Balser and Peter Koutoujian would authorize regulations to protect
people with psychiatric disabilities in Massachusetts emergency
departments.

 

This legislation is desperately needed. Currently, there are no state
rules limiting or even regulating the use of restraint, seclusion,
handcuffs, or forced stripping in emergency departments. The public
health and mental health departments, however, opposed the legislation,
stating they would instead work with hospitals to voluntarily improve
the treatment that people with psychiatric disabilities receive in
emergency departments. We hope that these promises will yield concrete
improvements; publicly available statistics about restraints of
psychiatric patients in emergency departments (as is required of all
inpatient psychiatric units) would be a good first step.

 

Yet while changing emergency department practices toward psychiatric
patients is essential, it is equally essential to prevent as many of
these emergency department visits as possible.

 

Yet the state could well take a step in the wrong direction. Proposed
regulations by the Department of Mental Health would allow people who
need psychiatric evaluations to be sent to emergency departments. A
better option would be to increase mental-health services for people
with psychiatric disabilities. This could include emergency service
workers who provide crisis evaluation in the community; nighttime crisis
services; and crisis beds outside emergency departments. Helping
patients get to medical appointments, find primary-care doctors, and pay
for medication would be more cost-effective and less traumatizing for
patients than a visit to an emergency room.

 

Emergency departments were never meant to be a home for the most
difficult clients of exhausted and underfunded social service agencies.
People with psychiatric disabilities need a better option. The answers
are out there; the question is whether the will to implement them
exists.

 

Susan Stefan is director of the National Emergency Department Project at
the Center for Public Representation.

 

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/11
/07/wrong_place_for_mental_health_care/  

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