State emergency departments, including Sturdy, serving as pick-up locations for behavioral health patients awaiting placement | Local News
Sturdy Memorial Hospital in Attleboro sees its share of urgent cases in its emergency room — heart attacks, strokes, accident victims.
But every Monday (weekends tend to be a busy time for ERs), up to 34% of the community hospital’s 32 ER beds are occupied by patients who don’t have any of these issues. . Instead, those dozen people were admitted seeking psychiatric help — or behavioral health care in today’s medical terminology. They may be there for a while.
For Dr. Ron Van Ness-Otunnu, chief of emergency medicine at Sturdy, it’s a symptom. “We have a completely fractured and broken system,” he said. It’s a system that fails to serve those with the most serious mental health needs and overwhelms the medical professionals trying to help them.
“We work like dogs,” he said.
In some cases, he had patients waiting almost a week for a psychiatric placement. It is particularly difficult for juvenile patients. “It’s hard being a teenager to begin with,” he said, but the isolation caused by a prolonged pandemic has only created more stress.
Of the 11 patients most recently awaiting psychiatric help, four were minors and one was a geriatric case. “We had some here waiting 20 days, one for 50 days waiting for a bed,” Van Ness-Otunnu said. Although he admits that this is an extreme example, the problem becomes a concern beyond a local emergency service.
The situation is sometimes referred to as a “psychiatric boarding school”. Patients suffering from a mental health crisis, whether brought on by extreme anxiety, clinical depression or a consequence of substance abuse, may end up in a hospital emergency department because they are not have no other treatment options and must wait there (or on a floor) until a psychiatric inpatient bed becomes available.
the Massachusetts Health and Hospital Association (MHA), a non-profit group representing 70 hospitals across the Commonwealth, has called it a “behavioral health crisis” and notes that the effects of COVID-19 have made the situation worse.
“The COVID-19 pandemic has exacerbated these issues by increasing the need for behavioral health services, heightening the acuity of patient behavioral health presentations, and making the challenges facing the behavioral health system – including a shortage of clinical and support staff – more complex,” the association said in a report in October. “Emergency departments and medical-surgical units were not designed to meet the needs of these healthy patients behavioral; yet these facilities now serve as the last available refuge for patients pending appropriate placement.
While it was a problem before the pandemic, “it is now a real crisis in all hospitals in the state. Thanks to our weekly reportswe have found that more than 500 behavioral health patients are routinely committed to hospitals, which serve as their last refuge while awaiting specialist placement,” Leigh Simons Youmans, senior director of health policy at MHA, said in a statement. sent by email. .
It has also become a matter of concern for the medical community nationwide.
And it’s not just about who occupies the space.
Patients waiting in the emergency room or medical/surgical units are not getting the treatment they need. This can affect their medical results.
“A recent study identified the characteristics of patients who were boarded compared to those who were not,” The Joint Commission reported study. “Non-residential patients were less likely to suffer from serious and persistent mental illnesses, had private insurance, had better social support and were able to receive outpatient mental health care in the community. In comparison, patients in the residency group appeared to have less outside social support, which contributed to difficulties in disposition planning. Many residential patients had few or no family or friends who could help assist or care for the patient safely within the community.
It doesn’t help that for people without insurance or their own primary care doctors, the ER may be the first place they go when they feel sick. The recent spike in COVID-19 cases has only added to this burden.
So far, Van Ness-Otunnu said, it hasn’t been necessary to turn anyone away from the ER, but just trying to find a private space to talk with a patient is a challenge. The same goes for arrangements to keep tabs on patients with mental health needs, some of whom are at risk of harming themselves. Sometimes that means moving patients.
“It’s kind of a game of chess every time,” he said.
Since October, the MHA has been regularly tracking figures across the Commonwealth as part of its efforts to raise awareness of the issue. For the seven-day period ending Jan. 24, the number of patients awaiting psychiatric evaluation and residency reached 671 at the 54 reporting hospitals statewide, up from 559 the previous week. .
In what the MHA designates as Region 5, which includes southeastern Massachusetts and Cape Cod, these patients occupied about 34% of emergency department bed capacity.
Sturdy, which does not have an on-site psychiatric unit – although it does have mental health professionals on staff – has to outsource its psychiatric patients. A look at a database of inpatient behavioral health facilities, maintained by Massachusetts Behavioral Health Access, used by hospital social workers to find available openings in real time shows why this is a challenge.
As of Friday, there were less than a dozen beds listed as available for adults within a 50-mile radius of Attleboro, six of them in the 22-patient secure unit at Brockton Hospital. (Although, as the website notes, the availability of these beds is not guaranteed.)
And it’s not like emergency rooms can choose who gets admitted. Noting that ER doctors are “jack-of-all-trades,” the philosophy is that “all comers have a right to care,” Van Ness-Otunnu said. And while he may want to help someone with a mental health crisis, sometimes “I find myself helpless.”
At every level, he said, there are doctors, nurses and technicians, “working so hard to keep the department running,” but add a behavioral health crisis and the “political pitfalls” of the COVID-19 pandemic and “there is a lot of frustration here.
The MHA urges a range of answers to the question.
This includes ensuring hospitals have the resources to care for patients while they are on board. The creation of a Behavioral Health Rates Task Force to assess ways to ensure the financial stability of behavioral health units and facilities and to enable behavioral health providers to pay their staff adequate salaries, l prohibiting clinical denials due to an administrative or technical defect in a claim, requiring coverage of all medically necessary mental health services and reducing administrative barriers for providers wishing to expand behavioral health services
The crisis caught the attention of the state government.
Last year, the Baker administration announced a plan to use $31 million in federal emergency funds to hire new behavioral health workers and pledged to add 248 psychiatric beds. To address staffing shortages, Massachusetts is investing $122 million in federal relief funds to help pay off student loans for those training to enter the field.
“Responding to this crisis for affected patients and families is a top priority for MHA members. Heads of State have been a valuable partner in this work and we hope that long-term solutions are on the horizon. We are grateful for the major funding put forward by elected officials over the past few months to create new beds, increase the healthcare workforce and make care more accessible to all patients in need,” said said Youmans of the MHA.
“Patients and families need to know that this is a 24/7 goal for hospitals and heads of state,” she added.
Van Ness-Otunnu said he would be grateful for help, as he is for the 18 National Guardsmen assigned to help with non-medical duties at Sturdy.
But, he said, help cannot come soon enough. “If these areas are not addressed,” he said, “we will start to look like the poorest parts of the world.” And despite America’s high level of medical technology, “if you look at basic mental health needs, we’re not doing it very well.”
The problem, he said, is that “our system is not currently set up to respond to the fact that … mental health is as important as physical health. It is a collapsed system that we have created.
He hopes that more attention to the issue will help. “People appalled by this will change things,” he said.