A “huge and largely unreported problem” is happening in ERs across the nation, one expert says.
“The extent to which ERs are now flooded with patients with mental illness is unprecedented,” said Dr. David R. Rubinow, chairman of the Department of Psychiatry at the School of Medicine at University of North Carolina, Chapel Hill.
And this overflow is “having a really destructive effect on health care delivery in general,” he added. “There are ERs now that are repeatedly on diversion – which means they can’t see any more patients – because there are so many patients with mental illness or behavioral problems that are populating the ER.”
A 2017 government report found that the overall number of emergency department visits increased nearly 15% from 2006 to 2014, yet ER visits by patients with mental or substance use disorders increased about 44% in the same period.
This supports Rubinow’s belief that ERs are a major provider of mental health care for a “very, very sizable percentage of patients” these days.
Dr. Catherine A. Marco, from her vantage point as an emergency physician professor at Wright State University in Dayton, Ohio, said, “we commonly see depression, anxiety, substance-related conditions and suicidal behavior.”
Firsthand experience suggests to Dr. Mark Pearlmutter, an emergency physician in Boston, that the most common mental health problems in emergency rooms are dual diagnoses, such as “substance abuse and depression, for example.” He’s also seen cases combining acute psychosis, bipolar disorder, suicidality, aggression and (mal) adjustment disorders.
“We’re the safety net,” he said.
On the opposite coast, Dr. Renee Y. Hsia, an attending physician at Zuckerberg San Francisco General Hospital and Trauma Center, also finds that the most prevalent psychiatric diagnoses among adults in the ER are alcohol-related disorders, anxiety disorders and suicide or intentional self-harm. Based on her own research of “avoidable” ER visits, she found that two of the top three discharge diagnoses were alcohol abuse and depressive disorder.
“There are very real spillover effects from this phenomenon, which affects not only our ability to care for these patients with psychiatric needs but all patients seeking care in the ER,” she said.
In addition to longer wait times for everyone, “spillover effects” include dissatisfied mental health patients and an assumption of potential violence in the ER, according to these doctors.
How one psychiatric patient sees the ER
Sharon Marshall, 43, says her multiple experiences in the ER as a psychiatric patient were “very upsetting.”
“They took your phone away, and you couldn’t communicate with anybody else in the world,” said Marshall, who has been diagnosed with schizophrenia. Being held in the ER for “hours and hours and hours,” during which time “you couldn’t get your questions answered,” means “you have very little control over your circumstances” and “you’re at their mercy,” she said. “Anybody would be upset.”