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New Government Report on Patient Dumping: Why Hospital Emergency Rooms are Not the Best Places to Treat Mental Health Emergencies

ED ambulance no entry

ED ambulance no entryThe United States Commission on Civil Rights has just released its 2014 Statutory Enforcement Report on Patient Dumping, which focuses on the admission and discharge practices of hospitals treating people with psychiatric disabilities.  Buried in this report is the finding that “mental health emergencies present unique challenges that may not be suitable for traditional emergency departments.”

The report does not elaborate on why traditional Emergency Rooms may not be the best environments to treat someone in an acute mental health crisis, but as a family member and mental health professional with more than thirty-five years of experience in the field, I am intimately acquainted with the reasons:

  • Lack of Privacy I recently accompanied a family member in crisis to our local ED only to run into a neighbor in the open cubicle next to ours.  He was accompanying his own family member, who was being treated for a serious medical condition.  My family member was so distraught and agitated, that she had to be guarded and at times restrained by two police officers, a hospital security guard and two orderlies, while the medical staff attempted to treat her.  Not only was she mortified by this experience, but the other patients and their families could not help but be distressed by her cries of protest and emotional anguish that persisted for nearly three hours until she could be transferred to a more appropriate setting.
  • Long Waits  My family member’s ER ordeal was blessedly short (less than three hours) compared to the days that some patients are parked in emergency rooms, dressed in nothing but a hospital gown, while they wait for an open bed at an appropriate mental health care setting.  Fortunately, I had a reserved bed waiting for her at a nearby psychiatric hospital.  Because of that, the entire admission process, from the first call to emergency responders to arrival on the in-patient unit, only took eleven hours.
  • Non-specialized Care  Anyone who has accompanied a loved one through this process knows that a mental health crisis is a real emergency.  Emergency Department personnel know this, too.  But they are used to treating large numbers of patients, many of whom are in need of urgent, life-sustaining care.  In the open, busy and sometimes chaotic environment of a hospital ER, patients in psychiatric crisis can be difficult for non-specialized staff to manage and contain, let alone effectively treat.

Recommendation #13 from the United States Commission on Civil Rights’ report holds that individuals in a mental health emergency who are not also threatened by a physical health emergency should have the “option for treatment at a facility that specializes in mental health issues, instead of requiring the individual be cared for at a traditional emergency department.”  This recommendation is a step in the right direction.  But the report lacks specifics on how to ensure this option exists for patients and their families.  Increasing the availability of beds in public and private mental health care settings and expanding the opportunities for direct admission to these facilities are the obvious solutions.  Families can also take matters into their own hands by avoiding Emergency Departments and making arrangements with mental health providers for direct admissions whenever possible.

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Jay Boll, Editor in Chief www.rtor.org