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Market realities keep psych patients waiting for care

October 17, 2016

Health leaders know firsthand how the legacy of deinstitutionalization has resulted in far too many psychiatric patients being stuck in a holding pattern in emergency departments (ED) nationwide, waiting for inpatient beds or some version of immediate specialty care. New data released Monday by the American College of Emergency Physicians (ACEP) helps to quantify the gravity of the issue.

In a poll of more than 1,700 emergency physicians, ACEP found that 48% report that psychiatric patients are held in their emergency departments waiting for an inpatient placement at least once a day, and more than 10% report that on their last shift alone, there were six to 10 patients waiting. How long is the wait? Twenty-one percent say it’s two to five days.

Five days is a long time for a patient with bipolar disorder or severe depression to wait for care, and the ED—with its round-the-clock activity, artificial lighting and alarming noises—is not exactly the ideal atmosphere for recovery, said Rebecca Parker, MD, FACEP, president of ACEP, in a call with reporters. She also noted that the ED has become the “dumping ground” for psychiatric patients.

“Literally, we don’t have the outpatient resources or the inpatient beds for them,” she said.

Lack of specialists

According to the poll, only 16.9% of emergency physicians say they have access to a psychiatrist on call in the ED, and more than 11% report having no one on call to respond to psychiatric emergencies.

Renee Hsia, MD, MSc, FACEP, author of a length-of-stay study presented at ACEP’s annual meeting, found that 23% of psychiatric patients stayed in the ED more than six hours waiting for care, compared to 10% of medical patients.

“It’s not a requirement for emergency departments to have a psychiatrist on call or any type of specialist—and we’re not saying we would propose this type of legislation,” Hsai said. “As a market-driven healthcare system, things work based on financial reimbursement. Because Medicaid and other payers pay less, there is a disincentive to take care of certain types of patients or certain disease profiles.”

Parker said a good start in addressing the issue would be for Congress to move forward on comprehensive legislation to reform the mental health system.

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