Countywide reductions in psychiatric services, both inpatient and outpatient, has led to more than triple the number of emergency psychiatric consults and a 55 percent increase in the lengths of stay for psychiatric patients in the emergency department.
“As is often the case, the emergency department catches everyone who falls through the cracks in the health care system,” said lead study author Arica Nesper, M.D., of the University of California at Davis School of Medicine. “People with mental illness did not stop needing care simply because the resources dried up. 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.”
Sacramento County in California decreased its inpatient psychiatric beds by half, from 100 to 50, and closed its outpatient unit in October 2009. This lead to a significant rise in the average number of daily psychiatry consults in the emergency department from 1.3 to 4.4. The average length of stay for patients requiring psychiatric consults increased by 55 percent, from 14.1 hours to 21.9 hours. Out of 1,392 patients under psychiatric evaluation, 350 patients were held in the emergency department longer than 24 hours.
The study period was 16 months: eight months before and after the cuts. Nearly 64,000 patients were analyzed for the number, type and duration of psychiatric visits.
Before the decrease in county mental health services, patients were able to go to an intake facility and stay if they needed to be hospitalized. Community mental health centers can provide a wide range of services, including assessment, crisis stabilization, behavioral therapy and medication. They may even provide nonmedical help, such as housing assistance.
Overall, psychiatric evaluations increased from one per day prior to service cuts to about four per day afterward. The types of problems people brought to the ER, including being assaultive or suicidal, aggravated. Fewer people were referred to a psychiatric hospital and more were sent home after services were cut.
“Between 2009 and 2011, $587 million was cut from mental health services in California,” said Dr. Nesper. “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. Ultimately, these cuts led to a five-fold increase in daily emergency department bed hours for psychiatric patients. That additional burden on emergency departments has ripple effects for all other patients and the community.”
Ellen Meara, of The Dartmouth Institute for Health Policy and Clinical Practice, suggested other factors, such as rising unemployment rates and lack of adequate mental health care, could also be behind an increase in hospital visits. She did not, however, dismiss the idea that such cuts have wide-ranging consequences.
“Readers should understand the importance of high-quality and readily available mental health services in our communities,” Nesper said. “A lack of available mental health resources has a profound impact on clinicians and staff working in the emergency department as well as patients.”
With demand for public mental health services so high, especially at a time of severe economic distress, the crisis in mental health care continues. The impact is felt throughout society as people go without the treatment they need.
Sovereign Health’s foremost priority is to provide the best evidence-based mental healthcare to its patients, all the while focused on their sustained recovery and well-being. If you or a loved one is currently struggling with a mental illness, contact us right away through our 24/7 helpline to learn more about our programs.