Limited reimbursement makes psychiatric care a losing proposition

For a snapshot of why so many psychiatric patients end up in the emergency department (ED)--and the problems that causes--take a look at Orange County, California.

The county lost 58 percent of its psychiatric beds between 1995 and 2012, the Orange County Register reported, leaving it with less than one-third the number of beds required for the county's population. Meanwhile, psychiatric patient volume in county emergency rooms (ERs) rose 47 percent between 2006 and 2011, the newspaper reported, even though total ED patient volume rose only 7 percent.

Hospital consolidation is partly to blame, the article said, but declining reimbursements for mental healthcare discourage hospitals from adding more psychiatric beds.

"The fear of individual hospitals is that if we build that capability (to handle more psych patients) and it becomes known in the community that we have fixed that problem, we are going to get every single psychotic emergency in the county, and the reimbursement system is not sustainable," Steve Moreau, CEO of St. Joseph Hospital in Orange, told the newspaper.

That factor, along with other pressures on the mental health system, leaves psychiatric patients spending hours or days in the ED waiting for a bed or for a mental health evaluation, the Register reported. But ERs aren't well-equipped to handle those patients.

Nearly 50 percent of the assaults against ER nurses came from psychiatric patients, California Healthline reported, citing a study by the Emergency Nurses Association.

In an effort to try to take some of the pressure off EDs, officials in neighborhing Los Angeles County opened a 22-bed mental health urgent care center in August. The center evaluates, counsels and treats patients, and will refer them to long-term treatment if necessary.

The problem isn't limited to California hospitals. In a survey by the American College of Emergency Physicians, 84 percent of respondents said their EDs "board" psychiatric patients.

For more information:
- read the Register article
- here's the California Healthline article
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