Mentally ill flood ER as states cut services
Mentally ill flood ER as states cut services
https://news.yahoo.com/mentally-ill-...131133880.html
CHICAGO/NEW YORK (Reuters) - On a recent shift at a Chicago emergency department, Dr. William Sullivan treated a newly homeless patient who was threatening to kill himself.
"He had been homeless for about two weeks. He hadn't showered or eaten a lot. He asked if we had a meal tray," said Sullivan, a physician at the University of Illinois Medical Center at Chicago and a past president of the Illinois College of Emergency Physicians.
Sullivan said the man kept repeating that he wanted to kill himself. "It seemed almost as if he was interested in being admitted."
Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies - attempted suicide, severe depression, psychosis - as states slash mental health services and the country's worst economic crisis since the Great Depression takes its toll.
This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.
"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.
Increased demand in mental health services
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.
Compounding the problem are patients with chronic mental illness who have been hurt by a squeeze on mental health services and find themselves with nowhere to go.
On top of that, doctors are seeing some cases where the patient's most critical need is a warm bed.
"The more I see these patients, the more I realize that if it's sleeting and raining outside, the emergency room is the only place they have," said Dr. R. Corey Waller, director of the Spectrum Health Medical Group Center for Integrative Medicine in Grand Rapids, Michigan.
Government agencies such as the National Institutes of Mental Health, the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration could not provide fresh data on use of psychiatric services in recent years.
But doctors from more than a dozen hospitals nationwide, mental health advocacy groups and state-funded agencies told Reuters they are all seeing a marked increase in psychiatric emergencies.
A WORSENING PROBLEM
The National Association of State Mental Health Program Directors (NASMHPD), an organization of state mental health directors, estimates that in the last three years states have cut $3.4 billion in mental health services, while an additional 400,000 people sought help at public mental health facilities.
In that same time frame, demand for community-based services climbed 56 percent, and demand for emergency room, state hospital and emergency psychiatric care climbed 18 percent, the organization said.
"This wasn't one round of cuts," says Ted Lutterman, director of research analysis at NASMHPD Research Institute. "It was three or four for many states, and multiple cuts during the year."
If the economy doesn't improve, next year could be worse because many community mental health agencies are cutting programs and using up reserve funds, says Linda Rosenberg, president of the National Council for Community Behavioral Healthcare.
"It's been horrible," she said. "Those that need it the most - the unemployed, those with tremendous family stress - have no insurance."
In the emergency room, this increased demand has meant doctors and social workers are spending hours and sometimes days trying to arrange care for psychiatric patients languishing in the emergency department, taking up beds that could be used for traditional types of trauma.
More than 70 percent of emergency department administrators said they have kept patients waiting in the emergency department for 24 hours, according to a 2010 survey of 600 hospital emergency department administrators by the Schumacher Group, which manages emergency departments across the country.
Ten percent said they had "boarded" patients for a week or more.
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.
FROM CITIES TO SMALL TOWNS
In North Carolina, the state has cut its inpatient psychiatric capacity by half since 2005, says Dr. Bret Nicks, an emergency physician at Wake Forest Baptist Medical Center in Winston-Salem and a spokesman for the American College of Emergency Physicians.
Nicks points to a report from the Institute of Medicine released in 2006 that found U.S. emergency departments were already overtaxed and overcrowded.
"Now you are adding in patients who are unsafe to leave but yet have nowhere to go," he said. "I consider patients with acute psychiatric needs as really the forgotten patient population in the U.S. right now."
Dr. Stephen Anderson is an emergency department doctor at Auburn Regional Medical Center, a mid-size suburban hospital outside of Seattle.
"When the economy is hurt they are some of the first to drop off the healthcare rolls," he said of local residents in the largely blue-collar community.
Anderson, who heads the Washington Chapter of the American College of Emergency Physicians, said the state has lost a third of its inpatient psychiatric beds in the past decade.
Lately he is seeing a marked escalation in patients with psychiatric problems turning up in the emergency department. In early December, a third of its beds were occupied with people in a psychiatric crisis who were not safe to return to the community.
The problem extends out to small towns.
Sullivan splits his time between the big emergency department at the University of Illinois Medical Center at Chicago and St. Margaret's Hospital, a tiny facility in Spring Valley, Illinois, about 100 miles southwest of the city.
On a recent shift, a young woman with schizophrenia arrived at the hospital. She had just lost her job and apartment and was living with relatives. She could not afford the medications that were keeping her illness in check.
The woman asked Sullivan to switch her prescriptions to drugs that could be found on the $4 discount list at Wal-Mart and other discount stores.
"I didn't feel comfortable doing that," Sullivan said, noting that emergency physicians are being asked to deliver specialized care that should be handled by a psychiatrist.
He found a healthcare facility about 25 miles away with a psychiatrist who could help, but even that presented a problem for the woman, who had no way of getting to the appointment.
"It's almost akin to having a cardiac patient come in and say, 'I need someone to adjust my defibrillator.' In the emergency department, we can do a lot, but there are some things we have to leave with the specialists," he said.
(Editing by Michele Gershberg and Eric Beech)
Re: Mentally ill flood ER as states cut services
Here's an hour long, common sense, macroeconomic historical overview of why these tragedies are happening. Even if the description of our nations system and recent history is familiar to you, it was for me, it is worth sticking it out to the end, cause there are some surprises for even the best informed. And reviewing this material is a good exercise. Much of it gets left out of the public discussions, no matter what ideological camp you happen to like.
The current economic disaster holds ominous potential for every single one of us. Even the "1%".
https://blip.tv/zgraphix/capitalism-...ltdown-5834895
Re: Mentally ill flood ER as states cut services
Yes I am already aware of the video; "Capitalism Hits the Fan".
I posted it some time back: 05/10/2010 https://www.waccobb.net/forums/showt...m+Hits+the+Fan
At the time it was on KPFA in audio archives: https://www.kpfa.org/archive/id/50695 and the video ; @ https://vodpod.com/watch/1479355-cap...-view-on-vimeo
(both still work, I just checked them today):wink:.
I was even able to download the the KPFA audio at the time and I was even able to DL the video into my hard drive so I can use them for further reference and share either one of them with others. Big Smile
I guess when (the) "they" decide to outsource the mental (so-called)-rehabilitation 'industry', the question is: Where in the world would the (so-called) "mental patients" be "sent" to!?
Of course in doing something like that, someone would have to be able to "make a profit"! And the emergency rooms would get even fewer in order to "pay" for the offshore scheme so the "treatment" on the "mentally ill" will be at taxpayer expense. They will be shipped to somewhere else offshore (India, China, Pakistan, or a new branch of Gitmo, re-classified FEMA camps run by Kellogg & Root, Halliburton or some other so-called "too big to fail" low-ball "private contract bidder" perhaps?); and; who knows what will become of the with the "mental Patients" with something like that?:gettinashot::whackasmilie::knocked:.
Quote:
Posted in reply to the post by "Mad" Miles:
Here's an hour long, common sense, macroeconomic historical overview of why these tragedies are happening. Even if the description of our nations system and recent history is familiar to you, it was for me, it is worth sticking it out to the end, cause there are some surprises for even the best informed. And reviewing this material is a good exercise. Much of it gets left out of the public discussions, no matter what ideological camp you happen to like.
The current economic disaster holds ominous potential for every single one of us. Even the "1%".
https://blip.tv/zgraphix/capitalism-...ltdown-5834895
Re: Mentally ill flood ER as states cut services
The mentally ill are already being outsourced, to State Prison and County Jails. And have been for decades.
I met many of them when they were assigned as my Bridging Education Program students at San Quentin in my three years teaching in the Reception Center. Or they were cellees or neighbors of my assigned students on the tier I worked in West Block.
Quite a number of them would complain about not getting their meds, or that they had been prescribed the wrong ones.
It was a daily complaint, one of many that indicated the complete dysfunction and insanity of the entire system.
When I went through the In Service Training required of all correctional employees, the Psychiatrist who gave the mental health portion of the week long course, started with, "Welcome to The Factory".
I took her to be implying that prison was a place where people are made insane, or made worse if already ill. Without saying it directly in front of the cops in the class.
I think she was also alluding to the famous scene in "Midnight Express".
Re: Mentally ill flood ER as states cut services
Quote:
"Mad" Miles;
(said):
The mentally ill are already being outsourced, to State Prison and County Jails. And have been for decades.
Yes I agree that the "treatment" of the 'severely, mentally ill' has been "outsourced" (away) from the healthcare system for the non "criminally insane" and in particular, the poor and uninsured into the "prison industrial complex".
Anyway, what I was saying is that now that many prisons here are so costly (unionized labor) and coupled with the reality that someone somewhere must make a profit on it and the fact of States crying :broke:broke(!) along with the politicized, manipulated, oversimplification of the economic so-called “deficit” and “debt”, situation that, there will be the inevitable conclusion somewhere within the 'leadership' of the financial “controllers” to seriously consider 'outsourcing'. Not to mention the lack of financial input so that schools for training people to be able to take care of the seriously mentally ill have been seriously compromised if not completely ignored and in some cases absolutely shunned in the first place.
It is with that thought that I fear that eventually, the actual detention and also the so-called "mental rehabilitation facilities" also, in particular, the labor just like everything else that gets “outsourced” is that The mental illness/(prison) 'industrial complex' will be also (too); but, there is another onerous (potential) caveat with one terrifying somewhat likely possibility (if outsourcing is actually going to be seriously considered) that could actually make it be appealing to the “powers that be” is a very real possibility (of), is; that there would be Tax and Duty exemptions that may be granted for that outsourced "service" as compared to other import-export 'items' or 'services’ that would make it financially palatable for both the multinationals that would be doing the so-called “service” and the politics.
This sort of reminds me of the times when Richard Nixon wanted to put more "Community Mental Health Centers" in with federal dollars but at the same time, what also had been going on somewhat behind the scene is that lobotomies were commonplace for many different kinds of mental patients as compared to today. A very scary thought!
Basically, mental illness sufferers today, in our society, are still to a high degree, the most misunderstood, despised, and as a direct result, discriminated :banned:against people of those who need the proper and humane kind of social understanding and medical attention in all of our society:anon::tear:.
