Upsurge in people with mental illness seeking treatment in emergency departments is taking toll on patient care

Apr 27 2004

A recent upsurge in people with mental illness seeking treatment in emergency departments is taking a significant toll on patient care and hospital resources nationwide, according to a new survey of emergency physicians conducted by the nation's leading mental health organizations and the American College of Emergency Physicians.

Six in 10 emergency physicians surveyed report that the increase in psychiatric patients is negatively affecting access to emergency medical care for all patients, causing longer wait times, fueling patient frustration, limiting the availability of hospital staff and decreasing the number of available emergency department beds.

Two-thirds (67 percent) of emergency physicians attribute the recent escalation of psychiatric patients to state health care budget cutbacks and the decreasing number of psychiatric beds. One in ten report there is nowhere else in the community where people with mental illness can receive treatment. Mental health leaders claim that without ongoing, community-based services, people may see their illnesses worsen and be forced to seek care in Emergency Departments.

The new survey by the American Psychiatric Association (APA), National Alliance for the Mentally Ill (NAMI) and National Mental Health Association (NMHA) is part of a larger campaign on the issue of access to treatment and services for people with mental illness. Seventy percent of emergency physicians report an increase in people with mental illness "boarding," which is when patients are admitted to the hospital and forced to wait in the emergency department until inpatient beds are available in the hospital.

More than 80 percent report that this practice of "boarding" negatively affects the care of emergency department patients. This agreement was almost universal (97 percent) among those who reported a rise in the "boarding" of psychiatric patients over the prior 6-12 months.

"Emergency department overcrowding is a growing and severe problem in the United States," said Dr. J. Brian Hancock, President of ACEP. "As dedicated as emergency physicians and nurses are to caring for patients, we are reaching a breaking point where we may not have the resources or the surge capacity to respond effectively.

This affects everyone's access to lifesaving medical care." The report finds psychiatric patients board in hospital emergency departments more than twice as long as other patients. And, emergency physicians say their staff spends more than twice as long looking for beds for psychiatric patients than for non-psychiatric patients. "The findings underscore the serious consequences state budget cuts to programs like Medicaid are having not only to people with mental illness, but on anyone who may find themselves in an emergency department," said James H. Scully, Jr., MD, Medical Director, APA.

Medicaid is the single largest source of financing for mental health care in the U.S. Other survey highlights include: * About 2/3 (67 percent) of the emergency physicians in this sample reported a decrease in the number of psychiatric beds in their region in the prior 6-12 months.

Those who reported such a decrease in beds were also more likely than those who did not to report an increase in the number of psychiatric patients "boarding" in their emergency departments: 85 percent for those who reported decreased beds compared to 52 percent for those who did not. * More than 90 percent of survey respondents say "boarding" people with mental illness reduces the availability of emergency staff, decreases the availability of beds in the emergency department (96 percent), causes longer waits for patients in the waiting room (85 percent), results in patient frustration (89 percent), and increases the number of times the hospital diverts ambulances to other hospitals (31 percent). "We caution states to think twice before slashing their Medicaid budgets.

These budget cuts force people with mental illness to seek care in emergency departments because they have nowhere else to turn," said Michael Faenza, MSSW, President and CEO, NMHA. "Nobody wins when this happens." "The increase in people with mental illness in emergency rooms is rapidly becoming a national crisis," said Michael Fitzpatrick, MSW, Acting Executive Director, NAMI. "Solutions require that policymakers understand the negative effects of these budget cuts on the community."

Methodology In March 2004, American College of Emergency Physicians fielded the Psychiatric Emergencies Survey in partnership with APA, NMHA and NAMI. The intent of this study was to research potential effects that recent trends in access to care for psychiatric patients have on emergency department environments.

This survey was conducted entirely online; survey invitation URLs were printed and disseminated through the March edition of the ACEP member newsletter, reaching an approximate 12,000 active members.

Between March 5 and March 23, 353 members accessed and provided responses to this survey. All responses reported in our data are for the 340 of those with enough experience to provide an informed perspective: those that had been providing direct patient care in an emergency department since 2002.

The active emergency physicians who responded to the survey come from all regions of the U.S. including 47 states and Puerto Rico, as well a broad variety of hospital settings: teaching and non-teaching hospitals; hospitals that serve predominantly urban, suburban, rural, and mixed suburban/rural and urban/suburban populations.

The patterns of response displayed in this report are remarkably similar for physicians in each of these hospital settings. ACEP is a national medical specialty society representing emergency medicine with more than 23,000 members. ACEP is committed to improving the quality of emergency care through continuing education, research and public education.

For more information, visit the ACEP website at http://www.acep.org. The American Psychiatric Association is a national medical specialty society, founded in 1844, whose 35,000 physician members specialize in the diagnosis, treatment and prevention of mental illnesses. For more information, visit the APA website at http://www.psych.org.