Psychiatric Patients Face Long Waits in California EDs

A lack of space and capacity at long-term care facilities and community clinics has led many Californians with mental health issues to seek care at emergency departments, which often are not equipped to handle such patients, the Orange County Register reports.

Steve Moreau, CEO of St. Joseph Hospital in Orange County, said, "There is no psychiatric emergency system in place. The default is for the police or a family member to take them to the nearest emergency room, and I can tell you that none of the [EDs], including ours, is built or equipped to deal with psychiatric emergencies."

Details of Wait Times

The number of psychiatric beds across California has declined in recent years. According to a California Hospital Association study, the number of psychiatric beds in Orange County fell by nearly 58% from 1995 to 2012, leaving just 16.6 beds for every 100,000 residents.

Psychiatric patients often have to wait hours or days for a mental health evaluation and, if necessary, for a psychiatric bed to open up.

For example:

• Officials at Hoag Hospital in Newport Beach say that mental health patients waited an average of 20 hours for ED treatment in September;
• St. Jude Medical Center in Fullerton had an average ED hold time of about 23 hours for patients who ultimately were admitted to psychiatric facilities; and
• St. Joseph Hospital had an average ED hold time of about 12 hours for mental health patients.

Randall Hagar, director of government relations at the California Psychiatric Association, said, "I'm hearing from all over the state about [EDs] being overrun by psych patients ... They can be kept in the [ED] three, four, five, even up to seven days."

Some of the wait time accounts for alcohol or drug intoxication recovery, according to the Register.

Meanwhile, EDs are left with less capacity to treat patients with other issues -- such as broken bones, burns or chest pain -- and such individuals often are diverted to other hospitals (Wolfson [1], Orange County Register, 10/26).

Lack of Psychiatric Beds for Younger Patients

The lack of psychiatric beds particularly affects adolescents, according to the Register.

In Orange County, there are 32 psychiatric beds for about 725,000 residents under age 18. The shortage of psychiatric beds particularly affects children under age 12, for which there are none available in Orange County.

In addition, experts say there is a shortage of mental health resources for children. A 2013 California HealthCare Foundation study found that about 33% of children in the state who had emotional difficulties had visited a mental health professional in the previous year (Wolfson [2], Orange County Register, 10/26). CHCF publishes California Healthline.

Risk to ED Nurses

When psychiatric patients are taken to EDs and made to wait long periods of time, some patients or their family members lash out through violent behavior to nurses, according to the Register.

A 2011 study by the Emergency Nurses Association found that:

• More than 48% of nurses reported being grabbed or pulled;
• 41% reported being punched or slapped;
• 36% reported being spit on; and
• Smaller percentages reported being bitten, kicked, sexually assaulted, stabbed and strangled.

The study found that nearly 50% of assaults involved psychiatric patients.

The California division of ENA plans to begin surveying ED nurses across the state three times per month about job-related violence in an attempt to predict the likelihood of attacks and the types of patients involved.

However, observers say hospitals are hesitant to participate in such surveys for fear that unions could use the findings to drive unionization efforts. In addition, hospitals are concerned about surveys finding violent incidents that were not reported to law enforcement authorities (Wolfson [3], Orange County Register, 10/26).