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Few Emergency Physicians Believe Mental Health System Works for Patients

There is no universal protocol for evaluating and treating psychiatric emergencies in the ED

More than 80% of emergency physicians believe that the mental health systems in place in their communities and surrounding regions are not providing optimal care for patients, according to a national survey of nearly 1,500 emergency physicians by the American College of Emergency Physicians (ACEP).

Forbes reports that the survey, conducted in July 2015, was recently released at ACEP’s annual Scientific Assembly, held this year in Boston. ACEP is the largest advocacy group for emergency physicians in the U.S.

Options for acute care for patients with psychiatric illness have been shrinking over the past several decades, in part reflecting more narrow networks by insurers, but also because of the lack of coordinated and connected care for those without financial resources who remain underinsured or uninsured.

According to the Centers for Disease Control and Prevention, nearly one in 25 adults in the U.S. — 13.6 million people — experiences a serious mental illness annually that significantly impairs their ability to function and engage in their daily activities. Patients with schizophrenia, depression, and other mood disorders constitute the highest rate of emergency department (ED) visits among those with chronic conditions. Yet faced with such daunting statistics, there is no universal protocol for the evaluation and treatment of patients who present with psychiatric emergencies to the ED.

In response to such data, and to address these ongoing challenges, leaders in emergency medicine and psychiatry are launching “COPE,” the Coalition on Psychiatric Emergencies, to help streamline and make improvements for patients who require urgent psychiatric intervention.

“More people are coming to emergency departments for help during psychiatric emergencies,” said Michael Gerardi, MD, FACEP, past president of ACEP and Chair of the COPE Steering Committee. “It’s time we think about doing things differently.”

“Through this unique collaboration, the Coalition on Psychiatric Emergencies will focus on developing a more unified treatment model and improving the treatment experience for both patients and for health care providers, while also saving hospital costs,” Gerardi added.

The survey by ACEP supports two other recent national surveys that demonstrate the current model for emergency psychiatric care is not optimal for ED patients and staff.

A recent survey by the National Alliance on Mental Illness (NAMI) found that close to 50% of patients were dissatisfied with their experience, and that more than 70% of patients waited more than 10 hours to see a mental health professional. And a recent study by the Emergency Nurses Association (ENA) noted that the bulk of ED nurses believe there is a lack of specialized training and education to care for patients with acute psychiatric emergencies, further compounding the situation.

COPE aims to:

  • Decrease waiting for inpatient psychiatric beds (“boarding”) for psychiatric patients in emergency rooms.
  • Ensure education and training for ED health care providers who care for patients experiencing psychiatric emergencies.
  • Ensure adequate funding and resources for treating psychiatric emergencies.
  • Drive improved quality and safety of diagnosis and treatment for psychiatric emergencies.
  • Advance research on psychiatric emergencies.
  • Develop a continuum of care to include prevention and aftercare.
  • Improve the patient and health care provider experience during a psychiatric emergency.

The survey was conducted online by the ACEP between July 1, 2015, and July 31, 2015. The response rate was 6% with a margin of error of 2.5%.

“ED physicians, psychiatrists, and patients all know the current system is not working,” said Amanda Itzkoff, MD, an Assistant Professor in the Department of Psychiatry at Mount Sinai Hospital in New York City who also maintains a private practice. “Psychiatrists and ED docs (and emergency psychiatrists) know that it’s not just that many of their patients suffer from psychiatric illness — the preponderance do.”

Itzkoff explains that psychiatric illness contributes to much “simultaneous cost and illness in the medical system.” Stated in other terms, “psychiatric illness causes the preponderance of illness — be that the psychiatric condition itself, the exacerbation of an underlying condition, or the acquiring of a new illness, condition, or state,” she added.

So what can we do? “The obvious answer is to treat the mental illness,” Itzkoff said. ”Historically, we have not attempted this. If mental illness is well treated, we stand to see a huge percentage of medical costs potentially disappear. Treating mental illness will improve our patients’ medical illnesses or lack thereof. So ultimately, treating mental illness successfully may be part of the ‘answer’ to providing better overall medical care and reducing cost.”

A lack of inpatient beds contributes to the ongoing problem with emergency psychiatric care, according to Itzkoff. “Hospitals do not want to ‘eat’ the cost of keeping such beds, which operate at a net loss in the system, especially when times are lean. The simple fact is they are necessary, and consequently we cannot treat an illness if we are eliminating availability of treatment for the very same illness,” Itzkoff stressed. “So the reflex is to ignore it and just stop spending on psychiatry since we don’t want to know about it. It’s time to pull our heads out of the sand.”

Source: Forbes, October 28, 2015.

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