Mental health professionals for decades have repeated the same old mantra to their patients in crisis — feeling suicidal and can’t reach me? Get yourself to a hospital’s emergency room (ER) as soon as possible.
Turns out, if you live in Massachusetts, that advice may not help much.
In a well-reported piece by Liz Kowalczyk in today’s Boston Globe, she details some of the ills facing Massachusetts’ ERs that try and cope with the growing influx of people with psychiatric and psychological issues. The problem is not new — not enough mental health resources in a system that is already strained just to provide emergency medical care in the state. The system is in desperate need of reform:
ER staff give psychiatric medications but are not trained to provide comprehensive psychiatric care, they said. And many of these patients stay in ERs for days without proper treatment because of backlogs in psychiatric facilities, creating potentially volatile situations for those patients, staff, and other patients. Hospital officials said nurses, too, have been injured in confrontations, and patients contend that they are humiliated by policies like the one requiring them to undress.
Everyone is unhappy with the current state of care. The patients are sometimes humiliated and dehumanized in a system that really focuses on and better understands traditional medical problems (like a broken arm) than emotional problems (like someone who is in a manic state of bipolar disorder).
“The emergency departments are overwhelmed,” said Dr. Paul Bulat, medical director of the emergency room at St. Luke’s Hospital in New Bedford. “We are seeing more violent patients and out-of-control patients. We’re seeing mental health problems much worse than we should be.”
Exactly. Another symptom of our failing healthcare system here in the U.S. is that when people don’t have insurance (or their insurance doesn’t cover them), they seek assistance at an ER. ERs, by law, cannot turn away people who have immediate medical needs but can’t pay for them. The government is supposed to pick up the tab — and does — but at reduced rates that make it impossible to adequately staff and fund ERs at the levels they should be.
So the state, putting the blame on the hospitals, sent a warning letter back in September 2006, that they should work harder to address these concerns, especially for those who are in psychiatric crises. But little has changed:
But patients and advocates for people with mental illness say problems remain rampant. They are pushing legislators to increase the mental health department’s role in regulating ER care and to require the public health department to develop “best practices” for treating psychiatric patients.
For better or worse in U.S. society, ERs are often the last refuge for people looking to end their lives. Instead of acknowledging these people are in enormous pain and need sensitive, attentive care, they get warehoused like cattle (as do many ordinary patients in ER settings).
But the real problem comes in the backlog of getting these people real mental health care outside of the ER. Many times the people might benefit from inpatient psychiatric care, but can’t get into one because the few that exist are full-up.
Still others need more intensive care than once-a-week outpatient therapy sessions, but less intensive than 24-hour inpatient psychiatric care. In most communities throughout Massachusetts (and most states), such care simply doesn’t exist. Where it does exist, there are often long wait-lists for people waiting to get in.
Dr. Auerbach sums up the situation nicely:
Dr. Bruce Auerbach, chief for emergency and ambulatory services at Sturdy Memorial Hospital in Attleboro, said hospitals need more resources, not more regulation. “When a patient who is having a behavioral health crisis is in my ER for four days not getting the intervention he needs — it’s a travesty in our healthcare system,” he said.
A travesty indeed.