California Case Shows How Mental Health Cuts Overload ERs

States cut five billion dollars in mental health services from 2009 to 2012, according to USA Today. A new article online in Annals of Emergency Medicine starkly illustrates the impact on one California county.

Sacramento County emergency departments saw more than triple the number of emergency psychiatric consults and 55 percent increases in lengths of stay for psychiatric patients in the first year after funding was slashed.

“As is often the case, the emergency department catches everyone who falls through the cracks in the health care system,” said lead study author Arica Nesper, M.D., M.A.S., of the University of California Davis School of Medicine in Sacramento.

“People with mental illness did not stop needing care simply because the resources dried up. Potentially serious complaints increased after reductions in mental health services, likely representing not only worse care of patients’ psychiatric issues but also the medical issues of patients with psychiatric problems.”

After Sacramento County in California decreased its inpatient psychiatric beds from 100 to 50 and closed its outpatient unit, the average number of daily psychiatry consults in the emergency department increased from 1.3 to 4.4. The average length of stay for patients requiring psychiatric consults in the emergency department increased by 55 percent, from 14.1 hours to 21.9 hours.

Three hundred and fifty patients (out of a total of 1,392 patients undergoing psychiatric evaluation) were held in the emergency department longer than 24 hours. The study period was 16 months: eight months before the cuts and eight months after.

“Between 2009 and 2011, $587 million was cut from mental health services in California,” said Nesper. “These cuts affect individual patients as well as communities and facilities like emergency departments that step in to care for patients who have nowhere else to turn.

“Ultimately, these cuts led to a five-fold increase in daily emergency department bed hours for psychiatric patients. That additional burden on emergency departments has ripple effects for all other patients and the community.”

Source: American College of Emergency Physicians/EurekAlert