Mental Health Access Crisis Hitting EDs

Mental illness has become a growing problem for California, according to two recent developments: a study chronicling an increase in mental health presentations in Sacramento County’s emergency departments and a lawsuit filed this month charging health officials in Los Angeles County with denying access to homeless patients with mental illness.

The study, started at UC-Davis, said emergency departments in Sacramento County handled three times as many emergency psychiatric consults with a 55% increase in length of stay for those psych patients in the emergency department after the county cut mental health services funding in October 2009. The study was published Nov. 13 in the Annals of Emergency Medicine.

The Nov. 18 civil rights lawsuit said homeless people with mental disabilities in Los Angeles County have been denied access to services because of a complex and chaotic application process that creates “a daunting and insurmountable barrier to securing … benefits.”

According to study author Arica Nesper, a resident physician at Stanford who started the study while a medical student at UC-Davis, reductions in county mental health services have hit emergency departments hard. The study bracketed its data around a large cut in county mental health services in 2009, when Sacramento County officials closed its outpatient psychiatric unit and trimmed the number of inpatient psychiatric unit beds in half.

The study looked at data from one year before the cuts and eight months after it, from October 2008 until May 2010, and found that:

• Psychiatric consults in Sacramento County emergency departments tripled over that 18-month period;
• The length of time spent by psychiatric patients in the emergency department rose by 55%, from 14.1 hours to 21.9 hours; and
• Taken together, the study said, those numbers equate to “a five-fold increase” in daily emergency department bed hours for psychiatric patients.

The study concluded the increase in psychiatric patient time in the emergency departments of Sacramento County was attributable to county cuts to mental health services.

“These cuts affect individual patients as well as communities, and facilities like emergency departments that step in to care for patients who have nowhere else to turn” Nesper said in a written statement. “That additional burden on emergency departments has ripple effects for all other patients and the community.”

The lawsuit, filed in U.S. District Court in Los Angeles, targeted Los Angeles County’s general relief program, which provides $221 per month for the destitute. It’s not just the application process that’s difficult for mentally ill homeless people to navigate, the suit said.

“The requirements that the [county’s Department of Public Social Services] imposes for obtaining and maintaining [general relief] benefits are even more onerous,” the lawsuit said. “For example, individuals must participate in three weeks of job training before their … applications will be approved. … [And] individuals must spend 80 additional hours every month in the job-readiness program. For many individuals with mental disabilities, these requirements are unreasonable and unrealistic.”