Hospital EDs Struggling To Care for More Mental Health Patients

Hospital emergency departments in California increasingly are having to provide care for individuals with mental health conditions, the Los Angeles Times reports.

Background

There has been a significant decline statewide in the number of acute inpatient psychiatric beds and funding for mental health care. According to the California Hospital Association, the state has about 6,500 psychiatric beds, down from about 8,500 in 1996. In addition, state funding to treat those with mental health conditions fell by 16%, or nearly $587 million, between 2009 and 2011, according to the National Alliance on Mental Illness.

Meanwhile, mental health care staffing has become an issue across the state, and many already crowded EDs are facing budget problems because of the economic downturn.

Los Angeles County Policy

In Los Angeles County, if hospitals do not have the psychiatric services to treat a patient, a physician will call on the county mental health department to send an evaluation team with the aim of transferring patients to psychiatric facilities. In some cases, the evaluation team could take more than 24 hours to respond, and EDs could end up holding a patient.

A new county policy could exacerbate ED overcrowding, according to hospitals and ED physicians. As of Aug. 1, the evaluation teams respond to EDs only when not needed by homes, schools, or in the community -- places where services are deemed to be needed more urgently.

Kathleen Piche -- a spokesperson for the county mental health department -- said the county is under no legal obligation to dispatch evaluation teams to hospitals. She added that hospitals could hire psychiatrists and contract with private facilities to evaluate and transfer patients.

Hospital Officials Weigh In

Marc Futernick -- director of emergency services for California Hospital Medical Center in Los Angeles -- said the county is financially and ethically responsible for evaluating and caring for uninsured patients with mental illness.

Jaime Garcia -- regional vice president of the Hospital Association of Southern California -- said county evaluation teams could employ technology to remotely assess patients.

Physicians have said a better way to address the issue would be to increase funding and provide more beds for patients with mental health conditions (Gorman, Los Angeles Times, 9/5).