Warehoused psych patients strain hospital EDs

Mental health patients often spend days in hospital emergency departments awaiting psychiatric treatment, with most of them requiring constant observation from medical staff, and many requiring special security, a new report finds.

New Hampshire's nonprofit Foundation for Health Communities issued the report Friday following a three-month study involving 575 patients treated at 15 of the state's 26 community hospitals. Study highlights include:

  • Nearly one in three patients seeking mental health treatment waited more than 24 hours in a hospital ED, with an average wait of 2.5 days. About 25 percent were diagnosed as suicidal.

  • More than half of patients recommended for an involuntary emergency psychiatric admission were in the ED for more than 24 hours.

  • More than 75 percent of the patients required constant observation in the ED, and special security was required for nearly half.

The report also noted the number of in-patient psychiatric beds in the state has fallen by 27 percent between 2005 and 2013.

Hospitals reported the increasing length of mental health patient ED stays is straining resources. One noted that while 75 patients required 760 man hours of one-on-one observation in January 2011, 73 patients required 1,477 ED man hours in January 2012, "acutely representative of the delays involved." At another hospital, ED officials spent $5,184 for a 24-hour detail for one violent patient.

Meanwhile, two teenage patients spent six days in a hopsital ED awaiting psychiatric beds. One of the patients required resources including local police, social services, hospital security and emergency services staff from two departments.

"We felt that by documenting it over a period of time, we could bring attention to the seriousness of the situation," foundation executive director and primary report author Shawn LaFrance said in a statement. "Bear in mind that this is a small sampling. It covers a three-month period with just 15 hospitals taking part, so it's really just a snapshot of the potential unmet need that exists."

Meanwhile, hospitals in Maryland have started sharing information about the availability on psychiatric beds to try to move mental health patients out of EDs into psychiatric units more quickly, Fierce Healthcare reported last week. Johns Hopkins, Sinai, St. Joseph Medical Center and Baltimore Washington Medical Center are among hospitals participating in the voluntary online registry.

To learn more:
-download the study (.pdf)
-read the highlights