Cuts in Mental Health Services Increase Psychiatric Emergencies

the Psychiatry Advisor take:

Cuts in both inpatient and outpatient psychiatric services in California has led to more than 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.

“People with mental illness did not stop needing care simply because the resources dried up,” lead study author Arica Nesper, MD, MAS, of the University of California Davis School of Medicine in Sacramento said in a press release. "Potentially serious complaints increased after reductions in mental health services, likely representing not only worse care of patients’ psychiatric issues but also the medical issues of patients with psychiatric problems.”

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 its inpatient psychiatric beds from 100 to 50.

After these cuts, daily psychiatry consults in the emergency department increased from an average of 1.3 to 4.4 visits per day. Patients also stayed an average of 55% longer, an increase from 14.1 hours to 21.9 hours. Out of 1392 patients undergoing psychiatric evaluation, 350 of them were kept in the emergency department longer than 24 hours.

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. “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,” said Dr. Nesper. “[The] additional burden on emergency departments has ripple effects for all other patients and the community."

Cuts in Mental Health Services Increase Psychiatric Emergencies
Cuts from mental health services in California has led to five times the daily emergency department bed hours for psychiatric patients.

Countywide reductions in psychiatric services — both inpatient and outpatient — led to more than triple the number of emergency psychiatric consults and 55% increases in lengths of stay for psychiatric patients in the emergency department. The before and after study of the impact of decreasing county mental health services was published online  in Annals of Emergency Medicine ('Impact of Decreasing County Mental Health Services on the Emergency Medicine').

After Sacramento County in California decreased its inpatient psychiatric beds from 100 to 50 and closed its outpatient unit, the average number of daily psychiatry consults in the emergency department increased from 1.3 to 4.4. 

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