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Psychiatric Patients Wait in Overcrowded ERs
By: Jane Ehrhardt
Zelia Baugh, MSW, LCSW, Brookwood Medical Center
Brookwood Expanding their Mental Health Department
A 2007 American Hospital Association survey found that nearly half of emergency departments are at or over capacity. A portion of the overcrowding results from the need to house psychiatric patients short-term. And with over half of the ERs in urban hospitals proclaiming an increase in boarding demand for behavioral health patients, the problem is escalating.
"Probably fifty to sixty percent of acute psychiatric patients come from the ER," says Zelia Baugh, MSW, LCSW, the administrative director of psychiatric services at Brookwood Medical Center. Acute can refer to patients with psychoses, schizophrenia, bipolar disorder, or suicidal tendencies.
Baugh estimates these patients wait anywhere from 18 hours to five days in Birmingham ERs until a psychiatric bed at a hospital opens up. Currently, the city hospital psychiatric beds total about 230 — Brookwood with 109, UAB at just over 80 and Trinity with 40.
While waiting, not only are the patients delayed in receiving the specialized treatment a psychiatric department can offer, but the ER beds and resources that may be needed for medical emergencies — particularly in this winter of a pandemic — are being taken up.
Baugh says that the number of ER beds occupied by psychiatric patients in limbo varies on any given day. "In each ER, you might have from one up to five," she says. "UAB often has more, because they're one of the few designated mental health facilities."
This designation means police and other officials can drop off patients, who have been committed by the probate court or required to undergo psych evaluation to determine commitment, at the UAB emergency department. "But we all function as designated mental health facilities in some manner, because UAB can't handle all that," Baugh says. The situation can be even bleaker in some of the rural outlying counties where psychiatric patients must wait in jail for a hospital bed to become available at times.
Most of the seven psychiatric wards at Brookwood have a waiting list. The shortest wait is for the 75-bed adult and intermediate care units for patients with major depression up through schizophrenia and probate court-held patients.
The longest wait, but generally the shortest list, is for the more resource-laden intensive care unit of five beds. Patients may have to linger for a week to ten days before a spot opens here.
This ward offers constant observation with one staff member for every two patients. The mental illnesses here run toward extreme suicidal tendencies, aggressive or homicidal schizophrenia, and severe intellectual disability. "This unit is full pretty much 99 percent of the time," Baugh says. There are usually one or two patients on the waiting list, with the normal stay in the unit running about three weeks versus three or four days in the other units.
"There's always been an issue of psych bed availability, but the impact on this needed service was severely increased when we lost Carraway's beds," Baugh says.
Carraway had been filling 45 to 50 psychiatric beds a day. When the hospital closed a year ago, Brookwood filed for an emergency Certificate of Need (CON) for psychiatric beds. They opened 16 beds on January 27 of this year, and within a day, all were full.
"We have the CON for 45 beds, but we only had the internal capacity to open 16," Baugh says. By the end of next year, however, Brookwood will be opening all 45 as they finish their structural expansion. Included in the 29 additional beds will be at least one more four-bed unit for the intensive care psych patients.
"We get phone calls almost daily from nursing homes and family members begging us to take their loved one, because they need help," Baugh says. "For someone with mental illness, if they're hearing voices yelling inside their head, sometimes to kill themselves or kill their neighbors, it's no different to them than the pain of you waiting a week to have an appendix removed. But with acute mental illness, the families know they or their loved one are not even safe as they wait."
Baugh believes the 45 additional beds will make a dent in the waiting lists, but not clear them up. "Brookwood is doing its fair share in being a community partner," she says, pointing out that they offer the most beds even before their expansion. "Brookwood is stepping up to the plate."
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