The following is an excerpt from “The Cost of Not Caring” by Liz Szabo published in the USA Today on May 13, 2014



In March, a psychotic patient spent two weeks in the same ER, waiting for a psychiatric bed to open up, says Ray Keller, medical director of the emergency room at Burlington’s Fletcher-Allen Healthcare, where Kelley was treated. “We’ve got patients living in our emergency department,” he says.

Mental health bed shortages are a national, man-made disaster that people rarely notice until it affects them, Keller says.

“We have to do something. It’s an abomination,” says Keller, noting that he sometimes wonders, “Can’t we get some FEMA trailers in here?”

For many people with mental illness, the ER can be a kind of purgatory.

They end up there because there are no services to keep them healthy. Even when all other resources have been cut, Keller says, “we’re the ones who don’t say no.”

In some hospitals, psychiatric patients get private rooms in the emergency department. Elsewhere, they may “board” in hallways, surrounded by noise, trauma and bright lights 24 hours a day, says Mark Pearlmutter, vice president and chief of emergency network services at Steward Health Care in the Boston area. Some patients are physically restrained.

The backups are so severe that they threaten the care given to all emergency patients, as those without mental illness are forced to wait longer for care, says John Bednar, medical director of Cone Health Emergency Services in Greensboro, N.C.

Those delays could be deadly, Bednar says, as patients with subtle but life-threatening conditions spend longer in the waiting room.

As states close hospital beds, the number of mentally ill patients boarded in the ER is growing, Bednar says.

Mental illness sends nearly 5.5 million people to emergency rooms each year, accounting for 4% of all visits, according to the federal Agency for Healthcare Research and Quality. Because many of the mentally ill are uninsured, hospitals often are uncompensated for their care, Pearlmutter says.

That increases the burden both on hospitals and taxpayers, who support emergency care through payments to medical centers that treat a “disproportionate share” of indigent patients. In fiscal year 2012, the USA spent $11.4 billion on these payments, about $456 million of that going to the care of the mentally ill.

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