Changing rooms: Emergency departments adapt to address mental illness
Waterloo-Cedar Falls CourierAug 30, 2016
There's fierce debate as to whether people with mental illnesses are on the rise or just better recognized. Schizophrenia rates, for example, have remained stable, while depression and anxiety appear to be increasing. Regardless of the reason, emergency departments staffs have updated their best health practices.
"They're not used to having people in their department for hours on end, and that may be the case with a behavioral health patient if we can't find a bed," said
Both Covenant and
Both hospital organizations also have brought in behavioral health consultants to assess and begin treatment immediately.
As they adapt, the hospitals and clinics see, better than most, the service gaps. They feel first-hand the crunch of constricting bed space.
Lack of beds
The stresses on the emergency departments created by a lack of bed space for crisis intervention services, particularly for youth who may face a much longer wait than adults, is one of the top five gaps being addressed by the
Both Covenant and Allen have mental health units. Covenant has 16 adult psychiatric beds and four adolescent beds for children 12 and older. Allen has 21 beds for adults, including people 16 and older.
But both Covenant and Allen say their units, designed for shorter-term care, are full the vast majority of time.
They're filled with both patients who come from their hospitals as well as hospitals from across the state. Latta estimates about 60 percent of Covenant's beds are occupied regularly by people from outside hospitals.
"It's entirely situational," Latta said of how long a person stays in the emergency department until a bed is found. "Historically, weekends, you have just about as high of a likelihood of winning the lottery as you do finding a psych bed in the state of
While they attribute much of the bed strain to the closure of two of the state's four mental health institutions, it alone does not account for the increased need.
She also noted a statewide system regularly shows vacancies in the 730 public and private beds serving adults and children available in the state, a situation many area providers dispute.
Area providers say the system is rarely current and doesn't distinguish between types of beds, as in it may show vacancies in the Cedar Valley when only the senior unit has openings.
Provider gaps
When it comes to providers,
"As we look to the top five, we know that we can't really make a difference in those areas, unless we, at the same time, are working on some of these obstacles," said
Covenant has a hospitalist who fills the role of a psychiatrist, though it has been recruiting for the latter for years. The demand for mental health services at
He currently relies on four psychiatrists who provide services through video chats, a service called telehealth. Three of the four live outside the state, but all are licensed to practice in
Eachus said it's helped cut the wait time for services from months to weeks, and about 85 percent of the center's clients have no problem with the service.
The gaps help make mental health drive up overall health care spending.
"We know that those patients can have a concomitant mental health diagnosis are twice as likely to visit the ER, use eight times as much resources in the dollar amount as someone who does not have a concomitant mental health diagnosis," Wilkins said. "It's a huge driver of health care."
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