Emergency rooms struggle to aid patients in psychiatric crisis

By Kristin Jones

Rocky Mountain PBS I-News

Growing demand for intensive mental-health treatment in the state and a decline in the supply of psychiatric beds have put added pressure on emergency rooms. In cases when patients pose a danger to themselves or others, ERs become the default holding place.

But without the capacity to offer psychiatric treatment or support, these ER holds offer little therapeutic benefit to patients, and drain resources for other urgent care, doctors and health officials say.

No state agency or association tracks the number of emergency mental-health holds in ERs across Colorado, but it’s safe to say the number runs well into the thousands every year. Several of the state’s major hospital operators, including the nonprofit Centura Health, which is Colorado’s largest hospital network, said they couldn’t provide the data for their own emergency rooms.

An exception was HealthONE, part of the for-profit Hospital Corporation of America that runs several hospitals and emergency departments in the Denver area, including the Medical Center of Aurora, Rose Medical Center and Swedish Medical Center.

In 2013, HealthONE emergency rooms had 2,600 mental health visits that resulted in mental-health holds because patients were a danger to themselves or others, or were gravely disabled. One in five was held in the ER for 24 hours or longer because no alternative was available.

Emergency rooms aren’t set up to offer patients long-term help. Just keeping patients secure can be a challenge. Occasionally, patients make a run for the door.

In September, for example, a patient at Aurora Medical Center “was unable to clarify to the (physician’s assistant) that he was not a threat to others,” according to an incident report filed with the state. The patient was being read his rights when he bolted from the room, through three sets of doors, out of the emergency department and into the street. He hadn’t been found more than three weeks later, when the report was filed.

The state in March made an effort to crack down on the use of emergency rooms to hold patients against their will. The Office of Behavioral Health warned that facilities that aren’t specially designated to provide psychiatric services “would be in violation of state law and could face legal actions for civil liberty violations” if they house people in involuntary mental-health holds.

Dr. Patrick Fox, an official with the Colorado Department of Human Services, said the state was concerned that mental-health holds in emergency rooms weren’t being tracked. Undesignated hospitals and emergency rooms aren’t subject to audits or inspections that go along with involuntary treatment, Fox added.

The Colorado Hospital Association quickly objected, saying hospitals have an obligation to evaluate and stabilize patients placed on mental-health holds by police or doctors.

Gail Finley, the hospital association’s vice president of rural health, added that rural hospitals in particular often have no choice but to try to provide a safe place for patients.

“We have a shortage of mental health providers,” Finley said, and poor reimbursement for psychiatric services. “It leads to sort of a weak system in providing care.”

The state later rescinded its warning.

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