"We know that patients who do have psychiatric disorders overuse the system," says Whitters. "What usually happens, due to liability concerns, is that ED physicians don't feel comfortable discharging a psychiatric patient. Someone says they're suicidal, they know the magic word to get into the hospital. Sometimes "three hots and a cot" does wonders."
For the psychiatric patients who are not overutilizers, Scott Zeller, MD, chief of psychiatric emergency services for the Alameda Health System in Alameda, CA, says too many organizations are not looking for alternatives to inpatient beds.
"It's the only area of medicine where the only solution for every [mental health] problem is admit to the hospital first and start treatment later," says Zeller. "It doesn't make any sense to me. It's as if you went to an ER having an asthma attack and they said, 'We're going to try to get you a hospital bed,' then finally they get you a hospital bed, and then start the inhaler treatment."
"It's the equivalent in psychiatry. Not nearly enough places are considering trying to do urgent treatment on arrival, seeing what they can do in those first 24 hours when so many patients can have their urgent symptoms relived."