Mental health issues: Invisible in plain sight

When a woman dies in a psych emergency department after waiting 24 hours to get a bed, people understandably focus on her death. And when nurses get punched, kicked and beaten by psychiatrically disturbed patients, activists decry violence in the workplace. All this is well and good. But what about looking at the root causes--the insufficiency of psych resources that help to trigger these problems in the first place?

As the debate in Congress over mental health parity in health insurance illustrates, there's no consensus in our society--or even in the healthcare industry--as to how to deal with the mentally ill. But it might be a good start to expose and focus on those issues, and the role they play in creating tragedies and violence in the healthcare workplace.

The lack of understanding and attention may be, in part, because mental health is on a separate track from just about all other healthcare services. Patients who present a mental health problem in primary care are referred to a psychiatrist and/or therapist, neither of which have much contact with the PCP. Patients who turn up in the emergency department with a mental health crisis are shunted to a psych ward without much of a medical workup, and they seldom get any counseling or other forms of psych support until they're placed in a bed in the psych unit.

No wonder the industry is ill-equipped to deal with mentally-ill patients. As long as mental healthcare is not only in short supply, but is also completely walled off from routine medical care, no one in the system is likely to know how to handle these cases. In my view, this needs to change, and fast.

Take the issue of nurses getting assaulted by irrational patients. Of course, it's horrible that anyone should be assaulted on the job. However, given that nurses in an ED can expect to encounter irrational and potentially violent patients regularly, why not train them in the restraint techniques used by psych specialists and give them more formal training in psychiatric management? Neither of these would prevent violent incidents from happening, but nurses would have much better tools to cope with them. And of course, it would be extremely helpful to offer counseling or other support to patients while they wait for psych services.

On the primary care level, why not contract with a mental health specialist even one day a week? Patients could see the psychiatrist--or even a less-costly counselor--who would report back directly to the primary care physician and help him or her understand that patient's needs. Such coordination could prevent many a sick patient's mental illness from escalating out of control.

I know, you're going to tell me that insurance companies won't pay for most of this. That may be true. But if we don't want mental healthcare issues to continue to skew the good work medical providers do, someone's going to have to take the bull by the horns. It's time to stop thinking about mental health care as living on some other planet and treat it as plain old medicine. - Anne