Mental health cuts increase emergencies

It is now accepted social truth in this country that the last 20 years or more of funding cuts, so unwisely effected for ALL the wrong reasons, have resulted in longer waiting times in community hospital ERs and the huge shifting by the hundreds of thousands of mentally ill patients to the local and state correctional systems, that it is almost trite to write about this. But as the saying goes, “the beat goes on,” due to the still misguided policies underlying mental health funding policies in this country.

It is so bad that this writer cannot refrain from penning a bastardization (sorry for the language momma…), “destroy them [inpatient psychiatric beds] and they will come…to the ERs and jails.”

In a November 23rd news excerpt in Eureka Alert website, entitled “Cuts in Mental Health Services Increase Psychiatric Emergencies,” it is stated that “Cuts in both inpatient and outpatient psychiatric services in California has laed to more tan triple the number of emergency psychiatric consults, and has increased psychiatric emergency department visit lengths by 55% according to research published in Annals of Emergency Medicine.

The study apparently looked at the service loads at the University of California Davis School of Medicine in Sacramento where the lead author Arica Nesper MD was based. It states succinctly that, “The researchers studied a level i academic university hospital adjacent to the county mental health treatment center for 8 months before and after Sacramento county in California closed its outpatient unit and reduced it inpatient psychiatric beds from 100 to 50.”

Patients were also noted to stay [in ERs, unit beds?] “an average of 55% longer,” and that, “Out of 1392 patients undergoing psychiatric evaluation, 350 of them were kept in the emergency department longer than 24 hours.”

The article further stated, “According to Dr. Nesper, $587 million was cut from mental health services in California between 2009 and 2011. This ultimately led to five times the daily emergency department bed hours for psychiatric patients. Dr. Nesper put all this in graphic perspective writing, “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. [The] additional burden on emergency departments has ripple effects for all other patients and community.”

The title of her article in the journal Annals of Emergency Medicine, was “Impact of Decreasing county Mental Health Services on Emergency Medicine.”

 

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Author: Frank

I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.

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