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Hospital Overcrowding Leaves Psychiatric Patients Without a Bed

November 09, 2016
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Hospital overcrowding may have an unfair effect on mental health patients, according to a recent study published in Health Affairs. In fact, results show psychiatric patients wait the longest for a bed at emergency rooms. Through an online survey answered by over 1,700 ER doctors and a decade of National Hospital Ambulatory Medical Care data, researchers discovered that over a third of physicians reported a minimum 48 hour wait time for psychiatric patients. Additionally, three out of four physicians surveyed saw at least one patient per shift that required psychiatric hospitalization. “ERs are the de facto dumping grounds for these patients,” said Renee Hsia, a director of health policy at the University of California at San Francisco, “Our ER departments are at their breaking points.” Suzanne Lippert, an emergency physician based in Stanford, California, experienced this statistic firsthand. When a woman contemplating suicide asked for an inpatient bed, Lippert was forced to “board” her for six days. “I thought this had to be an extraordinary case… I found out it’s not,” Lippert said. Ironically, as the number of psychiatric cases in emergency rooms rose, the number of state psychiatric beds dropped. From 2002 to 2011, mental health patients at the ER rose by 55 percent – a 2.4 million difference. Medical visits remained relatively static. On the other end, inpatient beds plummeted from 558,922 to 37,679 within half a decade. To make matters worse, half of the 37,679 beds available are reserved for forensic cases – beds meant for prison inmates and suspects. The problem may be tied to the lack of group homes or halfway houses available to psychiatric patients. However, this issue is not new; the lack of available inpatient beds started in the 1960s after a mass deinstitutionalization. While deinstitutionalization offered a benefit to patients, many were left without medical care or a home. The lack of ER psychiatrists may also directly affect patients’ wait times. Of the 1,700 physicians surveyed, only 17 percent reported having a psychiatrist on-call for mental health emergencies. Psychiatric resources in the hospital were also reported to have declined in the last year by more than half of the doctors. “There is not a requirement [for hospital ERs] to have a psychiatrist, or any specialist, on call,” Hsia added. Over the last decade, studies have shown how ER overcrowding negatively affects patients’ mortality rates, hospital costs and medical professionals’ stress levels. “The overcrowding won’t end anytime soon unless access to outpatient treatment centers expands,” said Rebecca Parker, the president of the American College of Emergency Physicians, “There are spillover effects on all [ER] patients because of these longer stays.” Lippert, along with other doctors, presented the study at the annual American College of Emergency Physicians conference. Lippert hopes the data will shine a light on the lack of resources for mental health cases in emergency rooms. “Nowhere else in medicine do we have our most severely ill patients staying the longest,” Lippert said.
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