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Strategies for ED Psych Patients

Jacqueline Fellows, for HealthLeaders Media, June 4, 2014

New models of collaboration (even among competitors) are producing shorter boarding times and fewer instances of aggressive behavior in the emergency department.

This article appears in the May 2014 issue of HealthLeaders magazine.

Three prominent scars on the forehead and cheeks of Virginia State Sen. Creigh Deeds are a recent and visible reminder that hospitals and health systems are straining to meet the mental health needs of patients across the country on a daily basis. Last November, Deeds' 24-year-old son, Austin "Gus" Deeds, attacked his father with a knife, slashing his head and torso, then killed himself—all within 24 hours of being released from a local emergency room because there wasn't a psychiatric bed available.

Deeds had taken his son, who was diagnosed as bipolar in 2011, to a hospital in November 2013, because of concerns about erratic behavior. With an emergency custody order in hand, Deeds as able to have his son in emergency care for six hours while hospital officials searched for a psychiatric inpatient bed. An appropriate bed couldn't be found within the time frame, so they returned home to what would be Gus Deeds' last night alive and the beginning of his father's fight for more mental health resources in Virginia's emergency rooms.

Not every psychiatric patient who is released too early from an ED commits violence or suicide, but nearly every ED in the country is struggling with the same issues: more psychiatric patients and not enough resources to properly treat them. In the face of this challenge, hospitals and health systems have had to form partnerships across departments and, in some cases, across town with competitors.

Success key No. 1: Collaboration among competitors

More and more patients with behavioral and mental health issues are showing up in EDs across the country because of the reductions in the number of psychiatric beds, mental health funding, and psychiatrists.

The National Alliance on Mental Illness, one of the largest nonprofit advocacy groups for people living with mental illness, estimates more than half of the states cut mental health budgets by $1.6 billion between 2009 and 2012. The Treatment Advocacy Center, another nonprofit aimed at helping mentally ill patients, released a 2012 study showing a 14% decrease in state-funded psychiatric beds from 2005 to 2010.

But as most states found out quickly, fewer beds doesn't mean fewer patients. Instead it means crowded EDs, says Jeff Klingler, CEO of the Central Ohio Hospital Council, which spearheaded an effort six years ago in central Ohio to coordinate psychiatric bed availability among competing hospitals.

"The situation had gotten so dire in 2008 that this was not an issue that a single institution was going to be able to manage by themselves," Klingler says. At the time, psychiatric patients were being boarded in hospital EDs for up to six days before a bed became available. "That's not good for the patients; that's not good for the hospital."

In May 2008, three large hospital systems serving the Columbus area joined together to form the Franklin County Mental Health Collaborative: Mount Carmel Health, a four-hospital system that is part of CHE-Trinity; OhioHealth, a nine-hospital nonprofit health system; and The Ohio State University Wexner Medical System, an academic medical center.

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