America's Mental Health System Update

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Patients with a diagnosed psychiatric problem are at increased odds of being in the emergency department for more than 24 hours.
Patients with a diagnosed psychiatric problem are at increased odds of being in the emergency department for more than 24 hours.

HealthDay News — One in five emergency physicians polled said they've had psychiatric patients who needed hospitalization who had to wait 2 to 5 days before being assigned an inpatient bed. The findings from the survey were presented at the annual meeting of the American College of Emergency Physicians (ACEP), held from Oct. 16 to 19 in Las Vegas.

Three-quarters of emergency physicians said at least once a shift they see a patient who needs hospitalization for mental illness, according to the poll of more than 1,700 emergency physicians. About half (48%) said that at least once a day, their emergency department ends up "boarding" a psychiatric patient who is awaiting admission to the hospital or transfer to another facility. Nearly 3 in 5 doctors (57%) also reported increased wait times and boarding for children with psychiatric illnesses. 

In addition, only 16.9% of doctors reported having a psychiatrist on call to respond to psychiatric emergencies in the emergency department. More than 11% said they have no one at all on call for mental health emergencies -- no social workers, psychologists, psychiatrists, or other professionals.

Two studies highlighted at ACEP's annual meeting further explained the deteriorating network of support for patients with mental illness. Patients with bipolar disorder, psychosis, depression, or a combination of two or more diagnosed psychiatric problems are at increased odds of being in the emergency department for more than 24 hours, according to one of the studies.

Another study provided more detail regarding the pressure that psychiatric patients are placing on hospitals and emergency departments: 21% of psychiatric patients require admission to the hospital, compared with 13.5% of medical patients; 23% of psychiatric patients wait in the emergency department more than six hours, versus 10% of medical patients; 7% of psychiatric patients stay in the emergency department for more than 12 hours, versus just over 2% of medical patients; and 11% of psychiatric patients end up transferred to another facility, compared with 1.4% of medical patients.

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