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Physicians Cite State Health
Care Budget Cuts at Root of Problem
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
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 toprograms 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
"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."
© CONTACTO Magazine
Published on April 27, 2004
the Digital Cover