Mentally ill filling ERs across U.S., study says

Monday, Aug. 9, 2004 | 11:08 a.m.

Two out of three hospital emergency rooms nationwide are becoming crowded with psychiatric patients, the same situation that led Clark County to declare a mental health emergency last month, according to a recent survey.

At the same time, the county appears to be the first municipality in the nation to confront the problem via an official state of emergency, said Stephen Epstein, spokesman for the American College of Emergency Physicians, the organization overseeing the survey.

"You seem to be at the worse end of the problem," Epstein said of the Las Vegas Valley.

The survey shows that emergency room overcrowding "is taking a significant toll on patient care and hospital resources nationwide," according to a story in the July issue of Hospitals & Health Networks, a national magazine for health care professionals.

"What you have is a group of patients who are mentally ill and (governments are) playing a sort of shell game" with them, said Epstein, who is also clinical operations director of the emergency department at Beth Israel Deaconess Medical Center in Boston.

The mentally ill "are out on the streets, they're not able to get good psychiatric care because of cutbacks, they're not taking their medication, they become psychotic and wind up in the emergency room -- and when they're discharged, there's still no one to provide care," he said.

The survey gave "an accurate picture of what we're facing here," said Karla Perez, chief executive officer for Spring Valley Hospital and president of the Facilities Advisory Board, a county group that includes top-level hospital administrators.

At the same time, Perez and others facing the crisis pointed to underlying issues they thought distinguished the valley from metropolitan areas elsewhere, ranging from population growth to a historical lack of state funding for psychiatric care.

One thing driving the problem in the Las Vegas Valley "is not just growth, but the kind of growth," said Jonna Triggs, director of Southern Nevada Adult Mental Health Services, an agency that receives $57 million in state funding to help the area's mentally ill who lack health insurance.

Triggs said she had seen recent numbers indicating that 40 percent of families in Clark County's school system qualified for free lunches, which suggests they are likely to be at a level of income that makes it hard for them to pay for health insurance.

"This means we're looking at a kind of growth that needs the state's services more," she said.

Davette Shea, director of emergency services at Southern Hills Hospital, said that Nevada has historically been stingy with its funding of mental health services, and suggested that the current crisis has been a long time coming.

"The problem is we've tolerated the problem for so long," Shea said.

As she spoke Friday afternoon, 6 of 22 beds in her hospital's emergency room were taken up by psychiatric patients, most of whom would have to wait at least two days to get beds in the state's psychiatric hospital.

Epstein said communities facing this problem nationwide need to support psychiatric care in the community, so that mentally ill people don't develop the type of conditions requiring hospitalization.

"Governments need to provide adequate funding for outpatient psychiatric care so that the mentally ill don't become acute patients," he said.

But Triggs said 70 percent of her budget is for community resources, including an outreach team that seeks out and attempts to treat mentally ill homeless men and women in the washes and streets of the valley. Thirty percent goes to the psychiatric hospital.

But neither pot of money seems to be enough, she said. Although prevention is vital, she said, at the present time there are more patients whose conditions are too serious for treatment outside a hospital than there are beds in the hospital.

Epstein said that political will to fund solutions may come about because of the declared state of emergency, since the situation could lead to delays and deterioration in care for patients with life-threatening conditions such as bullet wounds or heart attacks.

"When it finally affects the rest of the population who votes, then the problem is finally recognized," he said.