The illness hospitals don't want to treat

Nobody should have been surprised, but there it is. A study cited last week in FierceHealthcare concluded that the number of Americans with chronic mental health conditions is even larger than once suspected. 

For example, a full 41 percent of people aged 18 to 32 have experienced clinically significant depression, researchers said. All told, the prevalence of anxiety, depression and addiction may be roughly twice as high as mental health researchers in the U.S. have previously concluded, the study found.

Such people frequently turn up in hospital emergency departments, where their depression, anxiety, and addictions generate untold millions in needless medical bills -- consider the man with an anxiety attack who fears he's having a heart attack, or the depressive whose self-neglect has led to serious complications of chronic illnesses like diabetes.  Tests, nursing staff and physicians are deployed, the patient is calmed and treated, and they head out into the world with their root problems unaddressed.

That being the case, where are the master's-prepared social workers in emergency departments? You know, the people who have the training, inclination and experience to help the mentally ill and route them to community resources--or help them find inpatient treatment?  Largely absent, it seems.

I'll admit that I don't have statistical evidence for this, other than impressions gathered as a healthcare analyst. And I do know that some hospitals with active diversion programs use skilled social workers to move the worried-well and mildly ill to more appropriate settings like community health clinics. But I think it's telling that the most recent reference I could find on training social workers for emergency department work was published in, no joke, 1978.

Ultimately, my sense is that in most cases, virtually no one at the hospital's de facto front door is truly prepared to deal with the needs of the mentally ill.  In extreme cases, this leads to completely needless events like the death of Esmin Elizabeth Green, who died on the floor of New York City's Kings County Hospital Center while waiting, ignored, for an evaluation and admission to the psych unit.

More often, the failures of the system are less spectacular, but in some ways just as damaging. If nothing else, a hospital that can't deal with illnesses affecting nearly half the population is unprepared for an always-fermenting epidemic which far exceeds the H1N1 virus in viruence.

Come on, CFOs, I know times are tough. But is it really worth saving a relatively scant $50,000 to $75,000 per year if the cost is the capacity of your emergency department to treat a staggeringly common illness?  More importantly, is it worth the cost to human dignity to let the mentally ill remain in their private hell, misunderstood, when you might have helped?  Somehow, I doubt that fits your mission. So what are you going to do about it? -- Anne

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