Austin to deliberately dump mental health patients on ED’s: your waits to increase

Aah, Texas Mental Health: “Just Go to the ER”.

Some mental health patients to be diverted to ERs

State tells local mental health agency to stop overusing Austin State Hospital.

statesman.comBy Andrea Ball
Thursday, November 01, 2007

More people with mental illnesses could soon be sent to local emergency rooms instead of Austin State Hospital, and hospital officials say that could clog waiting rooms and cause longer waits for medical care throughout the Austin area.

On Nov. 8, the Austin Travis County Mental Health Mental Retardation Center will start reducing the number of people it sends to the state hospital by 43 percent — an estimated 600 to 900 people each year. Those people will be taken to emergency rooms, including ones at Brackenridge Hospital, Dell Children’s Medical Center of Central Texas, Heart Hospital of Austin and St. David’s Medical Center, said Jim Van Norman, MHMR’s medical director.

The only solution, Evans said, is to stabilize people in emergency rooms until a psychiatric hospital bed can be found.

“No one hates this more than we do,” Evans said.

Oh, I’d bet you’re wrong there, Mr. Evans.  The patients will hate it, their families will hate it,  the entire staff in the ED now caring for a patient they’re not equipped to deal with and cannot disposition will hate it more, and longer, than you.  (I keep deleting a really snarky line here: feel free to make your own).

The move has local emergency room doctors expressing concern.

“This is truly a disaster waiting to happen,” said Pat Crocker, chief of Dell Children’s emergency department. “It’s going to affect medical care for every citizen in Travis County.”

Dr. Chris Ziebell, medical director for the emergency department at Brackenridge Hospital, said the hospital isn’t equipped to be a mental health crisis center. There is no secure place to keep patients who may be violent or disruptive, and medical staffers are not trained to provide the specialized mental health care, he said.

“I can knock them unconscious, but that isn’t going to make the mental illness go away,” Ziebell said.

Meanwhile, those patients can tie up emergency room beds for several days while waiting to be admitted to a psychiatric hospital.

It’s a solution from the MHMR standpoint: patient not in their waiting room = problem solved!  Except all you’ve done is shifted the responsibility from those whose it is, to those who aren’t able to turn any patient away.  Unconscionable.

[Really good background on the roots of the problem and Austin’s reluctance to pay for what they use in the Texas Mental Health hospital system.]

Whatever the long-term solution, Ziebell hopes it doesn’t involve leaving mental health care to emergency room staff.

“Sending someone to the ER when they’re having a mental health crisis is like going to the proctologist when you have a heart problem,” he said. “This is not the right place for them to get treated.”

(All emphasis mine).  This is not a solution to the problem, it’s abdicating a responsibility.  And it’s shameful. 

Best of luck, Austin ED’s.


  1. I don’t know how it is in Texas, but if we held people in EDs until a facility could be found, they would be living in EDs indefinitely.

  2. This is a huge problem in Austin already – it’s hard to imagine that it’s going to get worse. I do know that recently ASH (Austin State Hospital) has started saying that they’re full (when in fact, they aren’t) just so patients will get sent to the ER for “medical clearance”, where they’ll sit for 12-24+ hours before finally getting shipped to ASH. Some patients already spend days in our ER waiting for a psych bed. It’s absolutely absurd!

  3. TheNewGuy says:

    As the health care system groans under the load, the grease trap will always be the ER.

    I don’t like it any more than any other doc… but I have the distinct feeling that nothing will happen until the whole mess grinds literally to a halt, and some congressman’s niece or nephew dies in a hall bed.

    Call me fatalistic, but it’s going to get far worse before it gets better. The death of a thousand cuts.

  4. Welcome to my world, my county decided to save money by closing the psych hospital. Now where do those patients go? To the local ER while we try, often fruitlessly, to find placement at another facility in the state. We have had more than one patient discharged after their 72 hour hold expired. some of them are a danger to us and the other patients.

  5. In some states committed patients and patients on 72 hour holds are housed in jails until a psych bed opens up. Housing a patient in the ER, while incovenient for the ER staff, is better than housing psychiatric patients in jails.

  6. Wow! I’ll mark Austin down as one more place not to practice when I get out of med school.

    SSG J