People visiting emergency departments because of mental health issues can expect longer wait times and a higher chance of being transferred to another facility, a new study finds.
Emergency department patients with mental health issues who were eventually transferred waited nearly two hours longer in 2011 than patients without psychiatric health issues, according to a study published in September’s Health Affairs.
In addition, emergency department psychiatric patients were transferred at six times the rate of patients without mental health issues, said lead study author Jane Zhu, MD, MPP, a national clinician scholar in the University of Pennsylvania Perelman School of Medicine’s Department of General Internal Medicine. The rate is partly due to a “critical scarcity” of resources such as inpatient psychiatric beds, Zhu said.
“Right now, emergency rooms are serving as de facto mental health providers,” Zhu told The Nation’s Health. “The ER is not equipped to serve in that role. Patients often are stabilized but don’t get treatment. Their high rates of transfer points to the fact that ERs are already strained and not always the best settings for people with mental health needs.”
The study looked at over 234,000 records of patients with and without psychiatric health issues from 2002 to 2011 in the National Hospital Ambulatory Medical Care Survey.
Overall, emergency department visits increased from 82.2 million in 2002 to nearly 107 million in 2011 — a nearly 30-percent increase. But psychiatric health-related visits increased by about 55 percent from 4.4 million in 2002 to 6.8 million in 2011.
Compared to non-psychiatric patients, the average length of stay — defined as time from initial triage to departure from the emergency department — was 35 minutes longer for psychiatric patients who were eventually discharged in 2002 and 33 minutes longer in 2011. For psychiatric patients whose visits ended with a transfer, the wait was 114 minutes longer in 2011 — up from 82 minutes longer in 2002.
Zhu said the length of stay is not just how much time patients wait to be discharged or admitted to the hospital. It reflects complex and multiple steps related to psychiatric care. Those steps include getting medical clearances to make sure there are no other underlying medical conditions, approving insurance coverage and calling in mental health specialists, who are often not housed in the emergency department, for an evaluation and recommendation.
Adding to the complexity is the fact that many psychiatric patients may be uninsured, have low incomes or lack transportation and housing — additional barriers to accessing mental health care-related services, Zhu said.
“Each step in that process adds to the amount of time in the ER, utilizing resources and not getting the appropriate treatment patients need,” said Zhu, who began her research at the University of California-San Francisco. “One big lesson from the data about discharge and transfer is that the process by which the emergency department manages psychiatric patients deserves some introspection.”
A potential solution to providing adequate care for patients with mental health issues are regional psychiatric emergency room departments with connections to nearby outpatient psychiatric facilities, Zhu said. She also noted the importance of integrated behavioral health models where patients are seen with primary care physicians and mental health care specialists together.
For more information, visit http://content.healthaffairs.org/content/35/9/1698.abstract
- Copyright The Nation’s Health, American Public Health Association
