The challenge of caring for mentally ill patients in the ER

Emergency room doctor physician stethoscope scrubs Getty/gordonsaunders
Mentally ill patients frequently end up in the emergency department, where they can face long wait times for care. (Getty/gordonsaunders)

Patients with complex mental health issues frequently end up in the emergency department, where they may wait hours or even days for a psychiatric bed.

This is especially true of patients who have a “dual diagnosis,” or have both a mental health disorder and a substance abuse problem. Judith Shindul-Rothschild, an associate professor of nursing at Boston College who has published research on ER wait times, told WBUR that a shrinking number of psychiatric beds is especially impacting children and adolescents.

The scenario plays out "over and over and over again," she said.

Patients with a dual diagnosis have trouble finding either substance abuse treatment or mental health treatment, as psychiatric facilities will often not accept addicts and addiction programs may not take in people with acute mental health issues, according to the article.

The vast majority of emergency physicians (80%) say community resources to treat patients with mental health conditions are lacking, which can exacerbate the problem. There is also a dearth of psychiatrists and mental health providers to treat these patients.

RELATED: Barriers to healthcare access persist for mentally ill patients

There are solutions on the table, however. In Massachusetts, a state bill backs a pilot at Taunton State Hospital that would move patients out of the emergency department for treatment as they awaited a psychiatric bed to be made available.

State legislators have also proposed adding $1 million to the state budget to help these patients be placed in an appropriate facility, reports WBUR.

In Ohio, agencies that work with mentally ill patients are coming together for several pilot programs, reports The Columbus Dispatch. One solution this group is considering is forming a hub where they could team up more effectively to help these patients.

First responders could bring people in psychiatric distress to a centralized location, and walk-ins could be accepted, connecting patients more quickly to emergency care and psychiatric centers as needed. Patient records would be on file to better coordinate care, according to the article.

“I always envision it as a control tower out of Port Columbus, where the planes are coming in, the planes are taking off and they have access to all the information,” Jeff Klingler, president and CEO of the Central Ohio Hospital Council, told the publication.

The group is analyzing if a building is feasible, and a report is expected in August.

RELATED: U.S. desperately needs psychiatrists, mental health services

Hospitals are also partnering with community groups to better treat mentally ill patients.

This can include programs that provide peer support and recovery coaching, or emergency department navigators to help this vulnerable population. Some are also embedding mental health specialists in intensive care units.