The Mental Health Strain on Emergency Departments

JASON LU – Recently, I had the opportunity to work with psychiatric patients in the Emergency Department, and what I witnessed in terms of their management was concerning. These patients were subjected to searches. They were admitted, confined to their designated wing, and kept under constant surveillance by healthcare workers and security guards. Many of them remained secluded in bleak, ligature-safe rooms. This issue is far from isolated; it’s endemic to the United States healthcare system.

To provide some context, emergency departments have seen a significant influx of psychiatric patients. In 2021, there were a staggering 5.8 million visits related to mental health issues in the ED. Furthermore, 11.1% of adults with mental illnesses lack insurance coverage. Unable to see proper psychiatric services they are left with no alternative but to turn to these emergency services. Even after admission, these patients might not receive the timely treatment they require. Those with quality health insurance coverage can be transferred to psychiatric hospitals within a matter of hours, but for the uninsured, this period can feel like a medical “limbo,” as they wait for days in the ED for care. These challenges have only intensified due to the ongoing mental health crisis in America; in 2019, 50 million Americans were suffering from some sort of mental illness

The complexities of mental health treatment extend beyond just addressing the mental health crisis. More often than not, these high-risk patients are “boarded” in the ED, waiting for suitable treatment. This, coupled with the lack of insurance coverage, has placed additional strain on emergency departments that are ill-equipped to handle these patients. Moreover, the shortage of psychiatrists has made access to proper mental health treatment increasingly difficult. Currently, none of the major hospital systems in Athens, GA, have an attending in-hospital psychiatrist. State-run Community Service Boards like Advantage Behavioral Health Systems provide some relief, but they are frequently operating at or beyond capacity.

It’s clear that these systemic issues demand reform. However, achieving this is far from straightforward. Effective mental health treatment requires a delicate interplay between government legislation, healthcare payers, and healthcare providers. While programs like the Affordable Care Act have enabled many Americans to access medical coverage, ED utilization for psychiatric issues has surprisingly increased, underscoring the complexity of medical mental health policy.

Despite these challenges, some potential solutions have been proposed and successfully implemented. The University of North Carolina Medical Center, for example, has introduced telepsychiatry in the EDs of other hospitals. This strategy helps alleviate the burden of psychiatric patients in the ED and enables them to receive the care they need–when they need it. Community-based approaches also show promise. Integrating mental health services into schools and homeless services not only reduces the strain on emergency services but also destigmatizes mental health issues and promotes awareness, although funding remains a limiting factor.

On a positive note, the increased utilization of emergency departments for psychiatric disorders indicates that our efforts to destigmatize mental health have made some progress. Now that patients are seeking treatment–it’s crucial that we provide it effectively.

Copy Editor – Shreyaanvi Sharath

Photography Source – https://www.aamc.org/news/treating-mental-illness-ed