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Emergency Rooms Struggle to Cope With Surge

Dec 28 2011 | Comments 4

A combination of service cuts and recession job losses is flooding hospital ERs with people suffering from psychological crises. This is in addition to the people who already rely on ERs for psych services and who are already taxing the system because there is a lack of alternatives. People who use crisis centers are not being given the appropriate tools to manage crisis on their own or to minimize crisis in their lives. People who use the ER because they’re uninsured are victims of a negligent healthcare system that forces people to wait until things turn dire. Then there are people who are homeless who are seeking food and shelter and have nowhere else to go. If you want to see how massively this country fails its citizens, a few nights at your local ER will do it. The new population is an added problem.

From Reuters:

“These are people without a previous psychiatric history who are coming in and telling us they’ve lost their jobs, they’ve lost sometimes their homes, they can’t provide for their families, and they are becoming severely depressed,” said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.

Visits to the hospital’s psychiatric emergency department have climbed 20 percent in the past three years.

“We’ve seen actually more very serious suicide attempts in that population than we had in the past as well,” she said.

Perhaps most disturbing is that people who come for care often don’t get it:

And many hospitals are not prepared for the increased caseload of psychiatric patients, says Randall Hagar, director of government affairs for the California Psychiatric Association.

California cut $587 million in state-funded mental health services in the past two years, the most of any state, according to the National Alliance on Mental Illness, a patient advocacy group.

“They don’t have secure holding rooms. They don’t have quiet spaces. They don’t have a lot of things you need to help calm down a person in an acute psychiatric crisis,” Hagar said.

“Often you have a patient strapped to a gurney in a hallway outside of the emergency department where social workers are desperately trying to find an inpatient bed,” he said.

My emphasis. Can you imagine anything more troubling than going for help and then getting restrained instead?

The reader who brought this article to my attention said:

I fear for too long the mental health system has been considered infinitely elastic. Sadly, my peers and I are not. I wish the general population was more familiar with the nature, timing, and extent of the services our nation’s mental health system provides and the outcomes it fosters. I fear a great many have come to believe with the advent of “safer and effective medications” consumers need little more then a pill. If this was true the system could be viewed as infinitely elastic. As you know, things are not so simple.

Though he was able to get media coverage for this issue in 2009, admissions in the county hospital in his area continue to increase, from 4,639 in 2009 to 5,693 in 2011. And from what we’re reading, the trend seems likely to continue.

liz | 10:18 AM | hospitals / hospitalization, mentally ill ERs, psych hospitalizations

Joe Says:

It is worth remembering that California’s passage of its Mental Health Services Act (Proposition 63) in 2004 was supposed to address longstanding systemic inadequacies. Section 2, paragraph (f) includes the following, “Cutting mental health services wastes lives and costs more.” Are states and counties which have cut funding for mental health services experiencing no less then what California knew would occur?

California’s Mental Health Services Act:

Dec 30 10:07 AM

Anonymous Says:

From 2009 article mentioned above, “A growing number of psychiatric patients — including adolescents — are spending days and in some cases more than a week in emergency departments without specialized care because there is no room for them at psychiatric hospitals.” Continues at

Dec 30 7:32 PM

Jerry Says:

During the health care reform debates, opponents of reform often repeated the narrative that the U.S. has the best health care system in the world, and that even the poor and uninsured can always get help at the Emergency Room.

But the U.S.’s two-tiered health care system — quality services with a plethora of specialists for those with adequate insurance coverage, and an overburdened triage system for everyone else — fails to provide adequate resources to those in psychiatric crisis, so now they languish in ERs that are ill-equipped to serve them. People with mental illnesses have never been an influential constituency, and as budget cutting continues, this situation will only get worse.

What does it say about a society when there’s an emergency in the Emergency Room?

Jan 1 7:23 PM

Gale Floros Says:

I feel so. I feel your article will certainly give those people a excellent reminding. And they will certainly express thanks to you later

Mar 30 2:11 PM


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