NOT LONG AGO, I was at the North Carolina General Assembly as part of the Coalition
2000 Advocacy Days looking for legislators to lobby about improving the current sad
state of services for those with mental illness. In the process, I stumbled into a mental
health subcommittee hearing where administrators and doctors from two hospitals,
Randolph in Asheboro and Moses Cone in Greensboro, made presentations about the
crises in their emergency departments caused by the backlog of mental health
admissions at state hospitals.
So, why should you care about mental illness and emergency rooms? As I have often
said as I prepared to talk to one of our state legislators about providing better and
more humane treatment for those afflicted with mental illness, I feel confident that the
facts will persuade anyone, at least anyone who has either a heart or a brain, that they
should care.
If you have a heart you will care for those already troubled by mental illness being
made to needlessly suffer a loss of freedom without purpose and you will be troubled
by the failure to give them proper treatment for their illness. As a human, you will care
about the welfare of another human.
If you have a brain you will care because you will see that neglect of proper treatment
of mental illness is wasting your tax dollars and jeopardizing the health and safety of
not only those who enter our medical system through your local hospital’s emergency
department — which is quite likely to be you and your family — but our society as a
whole.
How big a problem are mental health admissions for North Carolina emergency
departments? During the 2009 fiscal year, 135,536 people in mental health crises were
seen in emergency departments statewide, according to the North Carolina Division of
Public Health.
A decade or so of reducing mental health beds at the state level, without replacing
them with appropriate facilities at the local level, has led to a growing queue of patients
who need mental health hospitalization and who are left languishing in hospital
emergency departments across the state to the detriment of all involved.
For Randolph Hospital for the month of April 2011, over 25% of their 24-bed
emergency department capacity was used for “mental health holding,” that is,
warehousing patients in mental health crises until they can be evaluated and
transferred for treatment when a bed opens in an appropriate facility. This use of ER
capacity caused increased risk for other patients who also then experienced their own
lengthened waits. Other impacts include increased staff dissatisfaction and turnover as
well as exposure of other patients, visitors and staff to extreme behavior problems and
even violence — all while they trying to deal with other medical emergencies.
The cost of this mental health holding area (nurses, security guards, attendants,
medications, and support services) was estimated at $1,000,000 annually, at Randolph
alone, “for a service that is little more than a waiting room for those in need of transfer.”
On several occasions Randolph Hospital needed multiple law enforcement officers to
control patients who were in the midst of long waits for transfer. As an example, one
potentially dangerous patient spent six days waiting in its ER without a psychiatrist. “It
is a pattern that dangerous patients have longer waits because they are harder to
place,” the administrators said.
This example is not an aberration. At Moses Cone Hospital the average time spent in
the emergency department waiting for placement at Central Regional Hospital last year
was 5 1/2 days. I will repeat, in a hospital with a mental health unit, patients deemed
needing a higher level facility for treatment spent 5 1/2 days, on average, waiting in an
emergency department. For some it was longer.
On some days Moses Cone had as many as 19 mental health patients in an emergency
department with seven bays for patient holding. Mental health patients left in limbo are
straining staff resources, delaying treatment for patients with medical emergencies, and
disrupting the entire emergency department.
A difficult environment is made so uncomfortable that some people who come for
treatment elect to go home without receiving care. Unsurprisingly, the “left-without-
being-seen” rate increases when the emergency department is holding mental health
patients.
The goal of emergency departments is to stabilize patients and transfer them to the
next level of care as quickly as possible. As a Moses Cone administrator said, in a wild
understatement, “The emergency department is not an effective milieu for psychiatric
treatment.”
Reducing state hospital beds didn’t make mental illness go away. The evidence is it
made its impact worse for all parties involved. State hospitals need more beds, not
fewer, and community hospitals need greater capacity and the resources to admit more
patients, so the state hospital admission delays can be reduced. Doing so would not
just save money but help us regain an important portal to our medical system — and
maybe a little bit of our own humanity.
Gary D. Gaddy is a member of the board of the National Alliance on Mental Illness —
Orange County.
A version of this story was published in the Chapel Hill Herald on Friday May 27, 2011.
Copyright 2011 Gary D. Gaddy
garygaddy.com 