For decades, hospitals have strained to accommodate patients in psychiatric crisis in emergency rooms. The horror stories of failure abound:
Patients heavily sedated or shackled to gurneys for days while awaiting placement in a specialized psychiatric hospital, their symptoms exacerbated by the noise and chaos of emergency medicine. Long wait times in crowded ERs for people who show up with serious medical emergencies. High costs for taxpayers, insurers and families as patients languish longer than necessary in the most expensive place to get care.
"If you are living with schizophrenia or bipolar disorder, that is a really tough way to begin that road to recovery," said Dr. Jack Rozel, president of the American Association for Emergency Psychiatry.
In pockets across the country, hospitals are trying something new to address the unique needs of psychiatric patients: opening emergency units specifically designed to help stabilize and treat patients and connect them to longer-term resources and care. These psychiatric ERs aim to address the growing number of patients with mental health conditions who end up hospitalized because traditional emergency rooms don't have the time or expertise to treat the crisis.
The rate of ER visits involving psychoses, bipolar disorder, depression or anxiety jumped more than 50 percent from 2006 to 2013, according to the federal Agency for Healthcare Research and Quality. Roughly 1 in 8 emergency department visits now stem from mental illness or substance use disorders, the data show.
The psychiatric ERs, staffed with nurses, social workers and psychiatrists, work to treat and release patients in less than 24 hours, much as traditional emergency rooms handle physical ailments. Those who are well enough to go home get discharged, while those who need more treatment are admitted to the hospital or transferred to an inpatient facility.
There are now roughly 100 such units across the country, said Dr. Scott Zeller, vice president of acute psychiatry at Vituity, a physician-led organization that provides staffing and consulting services to medical centers nationwide.
Zeller pioneered the approach while working as chief of psychiatric emergency services at John George Psychiatric Hospital in Alameda County, Calif. Over time, he transformed the center from a traditional ward where restraints were common into one that treated patients in a more supportive, living-room like setting. The results _ in terms of both patient outcomes and cost-savings _ made Zeller a believer.
He is helping design 10 new units, including in California, Florida, Illinois and Tennessee. Each is distinct, accepting patients in somewhat different circumstances and offering a slightly different range of services.
Patients who arrive at an emergency room for psychiatric or substance use disorders are more than twice as likely to be admitted as other patients, federal data show. And yet about 80 percent of the time, Zeller said, patients' mental health crises can be resolved without a costly inpatient hospital stay. A patient may be having a psychotic episode because he fell off his medications, for example, or having drug-induced hallucinations.
"We need to treat people at the emergency level of care," he said. "The vast majority of psychiatric emergencies can be resolved in less than 24 hours."
