While the goal of coordinated care software is to help different providers who care for the same patient stay connected, that doesn’t mean that emergency room doctors across the U.S. will have the ability to treat mental health patients. All too often people with mental health problems find themselves heading to their local ER for help, where the often overworked doctors and nurses do not have the resources they need to properly care for them.
According to a recent article published by The New York Times, the costs of treating psychiatric patients in the ER are staggering, and states across the U.S. are desperately looking to ease these costs while providing patients with a higher quality care.
The news source explained that in 2010, more than 6.4 million visits to ERs across the country were made by people whose main medical issue was a mental health problem or substance abuse. This is a 28 percent increase from 2006, according to the the Agency for Healthcare Research and Quality. These numbers represent remarkably high health care costs. For example, by 2014 it is estimated that hospitals will spend $38.5 billion annually to treat these patients, compared to the $20.3 billion spent in 2003.
Hospitals cannot legally turn anyone away who’s seeking care, even though many ERs may not be equipped to treat a patient who’s experiencing psychological problems. The New York Times gave the example of one case at the University Medical Center of Southern Nevada in Las Vegas, where the hospital was forced to declare an “internal disaster” and turn away arriving ambulances for 12 hours when more than half of the emergency room beds were taken up by psychiatric patients. Furthermore, in January 2013, a person experiencing suicidal thoughts took her own life in an ER in New Mexico. Many ERs do not have staff available at all hours who are trained to treat mental health problems such as suicidal ideation, which is how chaotic situations like this ensue.
Working toward a better way
The New York Times explained that in Raleigh, N.C., health care providers are working to make sure that individuals with mental health problems get the care they need in the right facility, rather than in the ER. The news source told the story of a homeless man who with bipolar and schizophrenic disorders had contacted paramedics in Raleigh asking for help. He said that he didn’t think his medications were working and he needed medical treatment. In the past, the paramedics may have brought him to a local ER, but now there’s a new plan in place. The paramedics instead brought him to Holly Hill Hospital, a commercial psychiatric facility in the area.
“He doesn’t have a medical complaint, he’s just a mental health patient living on the street who’s looking for some help,” Michael Lyons, a paramedic supervisor for Wake County Emergency Medical Services, told the news source. “The good news is that he’s not going to an ER. That’s saving the hospital money and getting the patient to the most appropriate place for him.”
This program came about in Raleigh in response to the overwhelming number of people with mental health problems who were visiting ERs after a state psychiatric institution known as the Dorothea Dix Hospital closed its doors in 2012. However, the problem had existed before then.
The news source explained that in 2010, ER physician Brent Myers noticed that at the start of his shift a majority of the patients in the ER were those needing mental health care, rather than those experiencing physical problems. He helped create a system in which Wake County paramedics could ask patients a series of questions to determine their mental states. If they believed that an individual might be experiencing mental health problems, they would give him or her the option to go to the local ER or to another facility that would be better equipped to treat specific disorders. So far, the program has been successful, with more than half of patients agreeing to go to a mental health facility in 2012 rather than the ER.
Other states also looking to change
North Carolina is not the only state that has recognized that people with mental health problems need a different sort of treatment from the type traditionally given in an ER. The Maine Public Broadcasting Network recently reported that one hospital in the state has created a Behavioral Emergency Department, which is separate from the ER where people experiencing physical problems are treated.
This new department is made to look more like a hotel lobby than an ER, to help people feel calm and safe. Furthermore, it’s staffed by trained professionals who have worked with psychiatric patients in the past.
“Medical nurses are trained to focus on the medical illness. A psychiatric nurse is trained on the interpersonal communication. They have hours and hours training designed just to know how to de-escalate an upset patient, and that can be the difference between having to force a medicine on a patient to calm someone down versus just allowing them to calm down with emotional support,” Michael Kelley, M.D., told the news source. “And so we did find out very quickly, within the first month or two, the number of patients that had to be locked in a room, or given forced medicines, or strapped down, dropped by almost 400 percent.”
Kelley added that there is a shortage of psychiatrists in Maine, so it’s important for there to be emergency facilities that are able to care for individuals while they wait weeks or even months to get an appointment with a psychiatrist. The need is clear – Kelley explained that each month the hospital is visited by an estimated 450 patients who are in need of mental health treatment.
Individuals who are experiencing psychiatric problems need to be treated in facilities that have properly trained staff and the right tools, such as mental health software, to ensure that they are getting both the short and long-term care they need.