ED: Wrong Place for Mental Health Care

A terrific editorial right on point.  The author is Susan Stefan, who is director of the National Emergency Department Project at the Center for Public Representation.

Read it all, but here’s a good slice:

Wrong place for mental-health care

By Susan Stefan  |  November 7, 2007

Boston.comHOSPITAL emergency departments are among the least appropriate and most expensive places in Massachusetts for patients in psychiatric crisis. Yet these departments are where police, families, group homes, nursing homes, and others routinely take people who are agitated, panicked, or threatening to hurt themselves. Emergency departments are also where people go at the end of the month when their medications run out, when their primary physicians can’t see them for two weeks, when they are frightened or desperate and have nowhere to turn after 5 p.m. and their therapist’s answering machine tells them to go to the emergency room.

It’s very well written, and worth the time.

It also helps to explain why a lot of us in Emergency Medicine dislike the idea that we’re the “Safety Net” for all of societies’ problems.  We’re not trained and certainly not equipped to take care of every conceivable problem. 


  1. Much of what goes to the ER has no business being there.

  2. True Greg P but where else can it go when these patients can’t get in to be seen during regular hours let alone after hours by their PMD’s or Psychiatrists. Good luck getting alternative measures started. Our psychiatrists refuse to be bothered after hours which contributes to the long waits. They are credentialed as MD’s but will NOT perform a screening medical exam on their stable patients that they have already committed and all get sent to the ER for us ER Docs to perform the exam for them. Yep, ties up beds. After hours? Forget it. The only time we ever called the on call psychiatrist (paid to be on call even if sleeps all night) and asked them to actually come to the ER to see a patient (very rare case) he flat out refused saying it could wait. They will force patients to wait in the ER until regular office hours and tie up a bed as well as delay that patient’s care rather than write admission orders at night which would result in a prompt admission. Yep, Good luck with that.

  3. Jessica F. says:

    I stumbled on this blog via a google search. The article from Boston could easily be describing what is happening in my city of Austin, TX. As a social worker who used to work in an ER and is now at a freestanding psych hospital, I am outraged at the expectation that ERs will fill in for the lack of preventive care in this country. All we could do with psych patients in the ER was restrain and medicate until a psych bed opened up; which could take days. Now the state has ordered the Austin State Hospital not to take any new admissions for at least 4-6 weeks because they have been “over capacity” and the state wants several millions of dollars back before they allow ASH to take more admissions. In the meantime, they will be diverted to local ERs. There are two other psych hospitals here; one is on a two week wait list (so I hear) and the other, where I work, has a limited number (9) of beds for unfunded, the population most served by ASH. My colleagues and I know this will be a complete disaster and the ultimate loser will be these patients. There is already a shortage of psychiatrists in Austin, and none that work in the ERs, so understandably ER physicians are angry about having to pick up the slack. I guess we’ll just brace ourselves and hope ASH opens back up soon.

    Appreciate the article!


  4. Yes, and I just love it when the police bring in a pt for a psych eval, after having given them the choice to either go to jail, or to the hospital. DUH! This results in people who probably should have gone jail coming to us instead. Some few are actually admitted, but most just have their trip to jail delayed by a few hours.


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