Scott: The forgotten emergency

It used to be that most psychiatric patients were handled by mental health providers and psychiatric clinics or hospitals. But our emergency departments have become the default treatment option, as increased costs, legal exposure and declining resources have forced many psychiatric providers to stop offering emergency care.

The result has been catastrophic for both patients and emergency departments. Each year, S.C. emergency clinicians care for tens of thousands of patients with mental health emergencies who have nowhere else to turn and who arguably have suffered the most.

More than three-quarters of emergency departments nationwide have psychiatric patients waiting days to be admitted. Palmetto Health in Columbia admits more than 100 mental health patients each month, with two to three patients boarding each day in the emergency department. Last year, more than 80 patients a month sat in the emergency department at the Medical University of South Carolina for at least 24 hours before they were admitted. In small rural hospitals, it is not uncommon for mental health patients to spend a week in an emergency room without ever seeing a psychiatrist.

The consequences for mental health patients are staggering. Imagine your suicidal family member waiting a week in the emergency room for psychiatric treatment following a suicide attempt. The delay in specialty care causes her to miss work and lose her job. Following discharge, her depression worsens, and the cycle starts all over again.

If you think the mental health crisis in the emergency room won’t impact you, think again. For every emergency room bed needed for a suffering mental health patient, one less bed is available to a community in need of emergency services.

According to the Institute of Medicine, emergency department crowding is delaying treatments for life-saving interventions for heart attacks, stroke, pneumonia and sepsis.

If South Carolina wants to solve this crisis, we must understand that unmet substance abuse and other mental health needs are higher than around the nation (9.4 percent vs. 8.9 percent), the number of psychiatric inpatients beds is significantly lower than average (23 vs. 26 per 100,000 residents) and 31 percent of residents are either uninsured or underinsured. This is partially why South Carolina scored an “F” on a recent report card on access to emergency care, ranking 45th nationally.

Our immediate priority should be to recognize that we are doing a terrible job at preventing mental health emergencies. South Carolina spends just $58 per person for community mental health services, near the bottom in the nation. This trend must be reversed.

Next, we need to organize psychiatric emergency resources in the same way we organize trauma resources, through greater regionalization of care.

If your car flips on a rural highway, you are taken to a Level 1 trauma hospital, where you can be quickly assessed by experts. By permitting emergency departments and ambulances to transfer mental health patients directly to hospitals offering psychiatric consultation, we can reduce boarding times as much as 80 percent, decrease the need for inpatient admission and decrease costs.

Eligible South Carolinians lacking Medicaid should be enrolled. And since Medicaid likely will not be enough to cover our mental health care debts, we should consider establishing a psychiatric emergency fund, similar to the S.C. Trauma Fund, to support hospitals that provide psychiatric consultation and other services for mental health patients.

Finally, we can stabilize the situation by providing increased community resources through mental health crisis stabilization units and centers, providing early intervention for individuals with mental health, substance abuse and other problems.

By intervening before problems escalate, we can significantly reduce the need for hospital admission. We can also help patients during their most desperate hour.

This story was originally published February 1, 2016 at 12:41 AM with the headline "Scott: The forgotten emergency."