ER wait times show it’s time for mental health solutions, rep says

THINKSTOCK

STATE HOUSE, BOSTON, JUNE 5, 2017….For a mentally ill person in a crisis, it can be difficult to travel to an emergency room and seek help. But if they are able to make that trip, those patients are often left waiting for care for 16 to 24 hours at Massachusetts hospitals. That’s over three times longer than patients who wait about four hours to be seen for non-mental health care.

And without new laws, Speaker Pro Tempore Patricia Haddad says “nothing’s going to change.”

Looking to address emergency room wait times for patients who need mental health care, Haddad spoke before the Joint Committee on Mental Health, Substance Abuse and Recovery on Monday in support of two bills she filed to create a pilot program for mental health patients at Taunton State Hospital and intensive stabilization and treatment units within the state’s Department of Mental Health.

“Let’s get people into a setting where they’re actually getting help,” Haddad said. “And they’re not waiting for help, they’re actually getting it.”

Patients who visit Massachusetts emergency rooms seeking mental health care wait for an inpatient bed significantly longer than patients who require care not related to mental health, according to a study published in the Annals of Emergency Medicine, an international medical journal. Wait times climb higher for the uninsured and Medicaid enrollees, who are more likely to spend over 24 hours in the emergency department.

The study said “mental health boarding” consumes scarce emergency room resources and worsens crowding “so that other patients with undifferentiated, potentially life-threatening conditions wait longer to be seen and treated.”

“There are going to be backups, there are going to continue to be hospitals and private places that just can’t handle these people. So what happens very often is they stay in the emergency room until they calm down and then many of them, their families just take them out,” Haddad said. “They say okay, well the crisis has passed and we have nowhere to put this person and you’re saying there’s nowhere to go so after 24, 48, sometimes even 72 hours, they take them home.”

The two Haddad-sponsored bills, H 1064 and H 1065, were also filed by Sen. President Pro Tempore Marc Pacheco.

The first bill would create a pilot program at Taunton State Hospital to “accept medically stable, high acuity behavioral health and dual diagnosis patients from emergency departments in the Southeast region.” If a patient in need of mental health care cannot be placed in an appropriate setting within four hours of admission, the bill would require they be transferred to the pilot program.

Dual diagnosis, according to the bill, means a patient is mentally ill and has a substance abuse problem. The pilot department would be staffed by registered nurses and psychiatrists, among others.

Taunton State Hospital would be allowed to accept patients to the pilot program who are classified under Section 12 of Chapter 123 of the General Laws, meaning they are at serious risk of harming themselves or others due to mental illness.

“If we did something at Taunton State Hospital I think it would create a few new beds. And to me, that’s the answer,” Haddad said.

The second bill, H 1065, calls for the state Department of Mental Health to create at least two intensive stabilization and treatment units — one for men and one for women. The units would serve patients who “exhibit persistently aggressive of self-destructive behavior” or violent behavior that requires specialized care.

The units would provide services like evaluation, stabilization and psychiatric treatment. At the end of a patient’s stay, the staff would be responsible for developing a plan for the “safe and timely transfer” of the patient out of the intensive stabilization and treatment unit. Other services would include violence assessments, interpersonal conflict resolution strategies, critical incident debriefings and transfer evaluations.

According to the bill, “appropriate staffing” would include registered nurses, clinical social workers, mental health workers, psychiatrists, clinical psychologists and rehabilitation specialists — all who have undergone specialized training to work with the patient population the bill aims to help.

“For those who are very difficult to manage, they’re violent or whatever,” Haddad said. “We need to staff that with people who understand how difficult that job is and are willing to do it.”

A similar program at Taunton State Hospital that treated more than a dozen men with severe mental illness was shut down in 2003 in an effort to save money.

Haddad said long wait times will remain “the status quo” for patients who need mental health care if legislation is not passed.

“I’ve filed it before, I’ve talked about it before,” Haddad said.

Copyright 2017 State House News Service