Getting psychiatric patients out of ERs

By Timothy Pratt (contact)

Friday, Oct. 9, 2009 | 2 a.m.

Five years ago then-Clark County Manager Thom Reilly declared a crisis when about a third of the valley’s emergency rooms were filled with psychiatric patients, most of whom were waiting to be transferred to the state’s mental health hospital.

In June a regional coalition of organizations that deals with mental health issues held its first meeting in two years, in part because the day-to-day numbers of psychiatric patients in emergency room beds appeared to be exceeding those that triggered the emergency five years earlier.

Today a separate group is trying to straighten out a few long-standing obstacles to dealing with the issue. Chief among them is that the valley’s 14 acute-care hospitals and the state Department of Mental Health and Developmental Services have never agreed on how to screen psychiatric patients as required by law, how to transfer them to psychiatric care, or even how to count them.

Some hospitals don’t even share their counts with state or county officials.

When these problems are added to an ongoing shortage of psychiatric services, the result is that the mentally ill, many suicidal, often languish in emergency rooms without help, and the true size of the problem remains elusive, says Bill Welch, president of the Nevada Hospital Association.

Fortunately, all that may be about to change.

Welch’s group and state officials have been meeting for about two months to develop new policies and procedures for addressing the problems. The goal is for the valley’s hospitals and the state to adopt a uniform system for treating the mentally ill, resulting in better physical and psychiatric care.

In the decade that Welch has led the association, he said, hospitals have never used the same procedures for medically screening patients who arrive at emergency rooms needing treatment for psychiatric problems. As a result, hospitals don’t pass along the same screening results when those patients are transferred to the state mental health hospital, meaning the state’s medical staff gets different kinds of information on different patients, depending on where they come from. Sometimes, time is lost in the search for more information that may be needed for ongoing treatment, Welch said.

Uniform screening at the acute-care hospitals will improve patient flow through the emergency room — and help free up beds for those who need them, Welch said.

Welch said there also has been no uniform system for transferring patients to the state’s hospital at Southern Nevada Adult Mental Health Services in Las Vegas, or for tracking the process. This sometimes creates further delays in getting patients into psychiatric treatment.

Last, he said, each participant in the process has had its own way of classifying psychiatric patients, depending on where they are in the sequence of entering the hospital, screening and transferring. This has to stop because “we need to know the volume of these patients to assess the problem accurately,” Welch said. In the past, he recalled, different agencies have debated the numbers of psychiatric patients in the presence of legislators, making it harder to reach decisions about funding more services.

Welch said this knotty problem has persisted mostly because “there hasn’t been willingness to come to a consensus.” Now, he said, “we all have to leave our egos at the door and concede a little.”