Emergency departments in the USA are overwhelmed with mentally ill patients

According to a recent report by the American Medical Association, about half of the patients in the emergency room (ER) have mental health problems.

Фото: Depositphotos

The demand for mental health services in the emergency room is increasing so much that people with mental health problems spend more time in the ER than they should. The problem is that there are not enough beds in psychiatric institutions. This leads to long waiting times, which means that people do not get the help they need right away.

This fact has a truly devastating effect on the provision of medical care in general.

The government’s 2017 report for the year found that the total number of emergency room visits increased by almost 15% from 2006 to 2014 year, but visits by ER patients with mental or substance use disorders increased by about 44% over the same period.

Dr. Catherine A. Marco, from an emergency medical point of view in Toledo, Ohio, said: "We usually see depression, anxiety associated with conditions under psychoactive substances and suicidal behavior."

Direct experience suggests Dr. Mark Perlmutter, an emergency doctor in Boston, that the most common mental health problems in emergency departments are double diagnoses, such as, for example, “substance abuse and depression.” He also encountered cases combining acute psychosis, bipolar disorder, suicidality, aggression and adjustment disorders.

On the opposite coast, Dr. Renee Y. Xia, an attending physician at Zuckerberg San Francisco General Hospital and Trauma Center, also found that the most common psychiatric diagnoses among adults in the ER were alcohol use disorders, anxiety disorders, and suicidality or deliberate thoughts of self-harm. Based on her own research, she identified two of the three most common discharge diagnoses as alcohol abuse and depressive disorder.

According to these doctors, a long waiting time leads to dissatisfaction with patients with mental health and there is a threat of violence in the ER.

Why is this happening?

Xia points to the “lack of beds in psychiatric hospitals” as “a key factor contributing to overcrowding in the ER throughout the country.”

“Between 1970 and 2006, the state's psychiatric hospitals reduced capacity from 400 beds to 000,” Xia said.

Mental disorder hinders access to medical care.

Morris from UT Southwestern co-wrote a study that examined the mission of psychiatric patients in one of the largest public hospitals, Parkland Hospital in Dallas, with more than 1 million patient visits annually. The study showed that nearly three quarters of patients with mental disorders reapplied the same problem.

“Most patients simply could not keep track of their treatment,” Morris said, explaining that this could be due to patient confusion about accessing follow-up care or transportation issues.

Request for help

In recent years, the number of suicides in the United States has increased dramatically. Studies have shown that suicide risk drops dramatically when people call the national suicide hotline: 1-800-273-TALK.

On the lines work various specialists and volunteers who have been trained. According to advocates, confidentiality, round-the-clock availability, the ability to call at any time and personalized assistance contributed to success. The International Association for the Prevention of Suicides also provides contact information for crisis centers around the world.

ER problems

Dan Stevens, diagnosed with major depressive disorder with psychotic features, sees a therapist once a week and a doctor every three months. However, on two occasions, thoughts of suicide brought him to the emergency room.

To assess his condition, he had to wait four hours for the first time, for the second time about six or seven.

“The first time it took me four hours to talk to someone, the second time was about six or seven. They somehow calmed me, so I relaxed a little, instead of being alarmed and ready to harm myself. ”

Stevens believes that emergency care was necessary, given his condition. It allows for a longer waiting time, due to the fact that different doctors can care for a patient with a broken bone, but only specialists can treat a person who has mental health problems.

However, one aspect of his two ER admissions was "very humiliating," Stevens said: "The worst part was being followed from behind by a police officer."

According to Stevens, leaving ER can also be problematic for patients with mental health problems: “Usually you are taken away in handcuffs in a police car.” Although he understands why safety measures and restrictions may be necessary for some patients, he believes that these measures were not necessary in his case.

According to him, when he was treated as a criminal, the whole process made him feel worse.

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