Senate eyes mental health as emergency physicians express concerns about treatment options

On October 29, 2015, the Senate Committee on Health, Education, Labor & Pensions held a full committee hearing on the status of the country’s mental health and substance abuse treatments. The panel of witnesses was made up of the acting administrator of the Health Resources and Services Administration, the acting administrator of the Substance Abuse and Mental Health Services Administration, and the director of the National Institute of Mental Health. The witnesses emphasized the extent to which mental illness pervades the country’s population and the necessity of providing early treatment, as well as the challenges the industry faces providing the necessary services.

This hearing comes the same week that the American College of Emergency Physicians released survey results indicating that an overwhelming amount of emergency physicians think that the mental health system is failing patients. Almost 1,500 doctors responded to the survey, and the results emphasize the necessity of additional efforts to treat this population. Forbes reports that of patients with chronic conditions seen by emergency departments, those with mental illness and mood disorders are the most common.

An ongoing problem

The problem, however, is not new. On Christmas Day of 2013, the New York Times reported that emergency room costs for treating the mental ill were on the rise, forcing hospitals to find better ways of meeting their patient’s needs. In Raleigh, North Carolina, Holly Hill Hospital instituted a pilot program in which paramedics took mentally ill patients to the commercial psychiatric facility instead of the nearest emergency department.

According to the New York Times, federal estimates for the cost of treating the mentally ill in emergency rooms for 2014 hovered around $38.5 billion, a stark increase from 2003’s $20.3 billion. As the mental health system shifted toward new models of care, communities were not able to handle the burden. Some hospitals created separate emergency departments or extensions for the mentally ill. North Carolina, a state that felt the issue particularly deeply, responded by attempting to steer patients away from emergency departments altogether.

Solutions created more problems

In the 1960s, states began closing psychiatric facilities and reducing the number of beds available for these patients in an effort to provide community-based treatment. Yet during the economic downturn, funding was reduced to these programs and many went without care. Now, patients are showing up at emergency departments that are unable to properly handle the demand. The 2013 New York Times article revealed that WakeMed Health and Hospitals saw between 25 and 50 mentally ill patients each day. The hospital employs many people simply for the purpose of finding better options for care for these patients.

An op-ed in Raleigh’s The News & Observer in June 2015 provided an update, and the problem is still rampant. Mental health facilities are often full, and patients who first go to the emergency room have to wait an average of three-and-a-half days for an inpatient bed. No real treatment is provided beyond sedation during this wait. The article reported that WakeMed had 60 people waiting for an inpatient psychiatric bed at one time.

The pilot program helped by allowing paramedics to offer prospective patients the opportunity to go to a different type of facility as opposed to the emergency room. Other states took notice as they tried to come up with their own creative solutions. But some states have laws preventing ambulances from taking patients to anywhere besides an emergency room, and Medicare and Medicaid will usually not reimburse for transportation to alternative facilities.

How to COPE?

The newest effort to combat the problem will be launched by emergency and psychiatric physicians: the Coalition on Psychiatric Emergencies (COPE). Cope has several aims, such as decreasing waiting for psychiatric beds in emergency departments, providing better training for emergency physicians caring for psychiatric patients, advancing research, and developing plans for care that include prevention and follow up care. Dr. Amanda Itzkoff told Forbes that the best answer to reducing the costs of expensive psychiatric care is actually treating the illnesses. She feels that the  disappearing inpatient beds are a necessity and will ultimately improve outcomes.