Mentally ill flood ER as states cut services

[웃 910]

Mentally ill flood ER as states cut services

CHICAGO/NEW YORK (Reuters) - On a recent shift at a Chicago emergency department, Dr. William Sullivan treated a newly homeless patient who was threatening to kill himself.

"He had been homeless for about two weeks. He hadn't showered or eaten a lot. He asked if we had a meal tray," said Sullivan, a physician at the University of Illinois Medical Center at Chicago and a past president of the Illinois College of Emergency Physicians.

Sullivan said the man kept repeating that he wanted to kill himself. "It seemed almost as if he was interested in being admitted."

Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies - attempted suicide, severe depression, psychosis - as states slash mental health services and the country's worst economic crisis since the Great Depression takes its toll.

This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.

"These are people without a previous psychiatric history who are coming in and telling us they've lost their jobs, they've lost sometimes their homes, they can't provide for their families, and they are becoming severely depressed," said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.

Visits to the hospital's psychiatric emergency department have climbed 20 percent in the past three years.

"We've seen actually more very serious suicide attempts in that population than we had in the past as well," she said.

Compounding the problem are patients with chronic mental illness who have been hurt by a squeeze on mental health services and find themselves with nowhere to go.

On top of that, doctors are seeing some cases where the patient's most critical need is a warm bed.

"The more I see these patients, the more I realize that if it's sleeting and raining outside, the emergency room is the only place they have," said Dr. R. Corey Waller, director of the Spectrum Health Medical Group Center for Integrative Medicine in Grand Rapids, Michigan.

Government agencies such as the National Institutes of Mental Health, the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration could not provide fresh data on use of psychiatric services in recent years.

But doctors from more than a dozen hospitals nationwide, mental health advocacy groups and state-funded agencies told Reuters they are all seeing a marked increase in psychiatric emergencies.

A WORSENING PROBLEM

The National Association of State Mental Health Program Directors (NASMHPD), an organization of state mental health directors, estimates that in the last three years states have cut $3.4 billion in mental health services, while an additional 400,000 people sought help at public mental health facilities.

In that same time frame, demand for community-based services climbed 56 percent, and demand for emergency room, state hospital and emergency psychiatric care climbed 18 percent, the organization said.

"This wasn't one round of cuts," says Ted Lutterman, director of research analysis at NASMHPD Research Institute. "It was three or four for many states, and multiple cuts during the year."

If the economy doesn't improve, next year could be worse because many community mental health agencies are cutting programs and using up reserve funds, says Linda Rosenberg, president of the National Council for Community Behavioral Healthcare.

"It's been horrible," she said. "Those that need it the most - the unemployed, those with tremendous family stress - have no insurance."

In the emergency room, this increased demand has meant doctors and social workers are spending hours and sometimes days trying to arrange care for psychiatric patients languishing in the emergency department, taking up beds that could be used for traditional types of trauma.

More than 70 percent of emergency department administrators said they have kept patients waiting in the emergency department for 24 hours, according to a 2010 survey of 600 hospital emergency department administrators by the Schumacher Group, which manages emergency departments across the country.

Ten percent said they had "boarded" patients for a week or more.

And many hospitals are not prepared for the increased caseload of psychiatric patients, says Randall Hagar, director of government affairs for the California Psychiatric Association.

California cut $587 million in state-funded mental health services in the past two years, the most of any state, according to the National Alliance on Mental Illness, a patient advocacy group.

"They don't have secure holding rooms. They don't have quiet spaces. They don't have a lot of things you need to help calm down a person in an acute psychiatric crisis," Hagar said.

"Often you have a patient strapped to a gurney in a hallway outside of the emergency department where social workers are desperately trying to find an inpatient bed," he said.

FROM CITIES TO SMALL TOWNS

In North Carolina, the state has cut its inpatient psychiatric capacity by half since 2005, says Dr. Bret Nicks, an emergency physician at Wake Forest Baptist Medical Center in Winston-Salem and a spokesman for the American College of Emergency Physicians.

Nicks points to a report from the Institute of Medicine released in 2006 that found U.S. emergency departments were already overtaxed and overcrowded.

"Now you are adding in patients who are unsafe to leave but yet have nowhere to go," he said. "I consider patients with acute psychiatric needs as really the forgotten patient population in the U.S. right now."

Dr. Stephen Anderson is an emergency department doctor at Auburn Regional Medical Center, a mid-size suburban hospital outside of Seattle.

"When the economy is hurt they are some of the first to drop off the healthcare rolls," he said of local residents in the largely blue-collar community.

Anderson, who heads the Washington Chapter of the American College of Emergency Physicians, said the state has lost a third of its inpatient psychiatric beds in the past decade.

Lately he is seeing a marked escalation in patients with psychiatric problems turning up in the emergency department. In early December, a third of its beds were occupied with people in a psychiatric crisis who were not safe to return to the community.

The problem extends out to small towns.

Sullivan splits his time between the big emergency department at the University of Illinois Medical Center at Chicago and St. Margaret's Hospital, a tiny facility in Spring Valley, Illinois, about 100 miles southwest of the city.

On a recent shift, a young woman with schizophrenia arrived at the hospital. She had just lost her job and apartment and was living with relatives. She could not afford the medications that were keeping her illness in check.

The woman asked Sullivan to switch her prescriptions to drugs that could be found on the $4 discount list at Wal-Mart and other discount stores.

"I didn't feel comfortable doing that," Sullivan said, noting that emergency physicians are being asked to deliver specialized care that should be handled by a psychiatrist.

He found a healthcare facility about 25 miles away with a psychiatrist who could help, but even that presented a problem for the woman, who had no way of getting to the appointment.

"It's almost akin to having a cardiac patient come in and say, 'I need someone to adjust my defibrillator.' In the emergency department, we can do a lot, but there are some things we have to leave with the specialists," he said.

http://www.healthnews.com/en/news/Mentally-ill-flood-ER-as-states-cut-services/3Q9RNCwFL0SPDCaFLEXPT2/

[Darnell 8,478]

Sorry - any 'slush money' that could have been used for a temporary fix for these folk? Got ate up with illegal aliens getting free care at the hospitals cross the country.

[mr and mrs 187]

poor mental health is frequently at the root of other social problems (homelessness, drugs, unemployment, etc).

addressing mental health issues is a very effective way of treating those other social issues. example: one of the best ways to keep vulnerable people off the streets and in jobs is keeping/getting them on their prescribed medications.

some may just chalk up homeless/unemployed people as fckups, but really, they are handicapped.

[Gary and Alla 3,694]

poor mental health is frequently at the root of other social problems (homelessness, drugs, unemployment, etc).

addressing mental health issues is a very effective way of treating those other social issues. example: one of the best ways to keep vulnerable people off the streets and in jobs is keeping/getting them on their prescribed medications.

some may just chalk up homeless/unemployed people as fckups, but really, they are handicapped.

Yep.

We should pass a TAX on the exploitation of illegal aliens for use as cheap labor to avoid our wage and hour laws and protections for workers. Make it economically impossible to exploit illegal aliens by business for profit and their will be a lot of money available to help our mentally ill citizens and legal residents.

Require e-verify for every new hire, make e-verify available to anyone hiring even a contractor to work on their home.

We need to remove the burden placed on our states by business avoiding paying proper wages and giving proper benefits to workers just because they are brown. Enough of these people lining their pockets with cash, abusing humans and causing Americans to lose benefits we pay for.

[I AM NOT THAT GUY 5,715]

Slow Elk. Predators gotta eat too.

Edited December 27, 2011 by ☼

[SuperDuper! 230]

Unfortunately, Mental Health is not considered a real medical or public health problem, until stories/situations like this ER story become intolerable or bankrupting.

In major cities and counties, if you take the top 25 homeless mentally ill types that access the ER and other county social services regularly (known as the frequent flyers), it literally less expensive to provide this 25 folks with a section 8 apartment, social security benefits, free monthly health care insurance with HMO, and a case manager. But only a few cities/counties are this progressive and do a program like this.

Meanwhile, such stories help explain why the average adult's monthly health care premium costs $500 or more.

The system is broken, but I'm glad Obamacare is being shot down. Don't know what the answer is, but it ain't Obamacare.

[Gary and Alla 3,694]

Unfortunately, Mental Health is not considered a real medical or public health problem, until stories/situations like this ER story become intolerable or bankrupting.

In major cities and counties, if you take the top 25 homeless mentally ill types that access the ER and other county social services regularly (known as the frequent flyers), it literally less expensive to provide this 25 folks with a section 8 apartment, social security benefits, free monthly health care insurance with HMO, and a case manager. But only a few cities/counties are this progressive and do a program like this.

Meanwhile, such stories help explain why the average adult's monthly health care premium costs $500 or more.

The system is broken, but I'm glad Obamacare is being shot down. Don't know what the answer is, but it ain't Obamacare.

States have their resources stretched to subsidize a cheap labor force so employers can pocket cash by exploiting people they do not have to provide healthcare to or even pay payroll tax on. It is impossible to provide any sort of healthcare for Americans when the resources are being gobbled up to support what is basically slavery. It is preposterous.

There are a few fundamental things things we need to adress before even talking about anything else.

1. Make it economically impossible to exploit illegals and avoid the costs of a system designed to benefit everyone

2. Implement a revenue system that cannot be tampered with and used as a political football.

I suggest FAIR TAX

THEN we can address all sorts of other things with the resources we will have available.

[SuperDuper! 230]

Makes a lot of sense, Gary.

[Bad_Daddy 2,209]

Sorry - any 'slush money' that could have been used for a temporary fix for these folk? Got ate up with illegal aliens getting free care at the hospitals cross the country.

[I AM NOT THAT GUY 5,715]

For the most part, undocumented workers pay the same state and federal taxes as all wage earners, he said. “They pay sales taxes like everyone else. They pay property taxes either implicitly or through their monthly rent.”

Even if they work under some sort of false identification, undocumented immigrants still contribute to Social Security and Medicare despite being ineligible to collect any benefits from those programs.

In 2007, the chief actuary for the Social Security Administration estimated undocumented immigrants contributed about $12 billion to the trust fund that year — money they will be unable to collect unless they become legal residents.

“Our projections suggest that the presence of unauthorized immigrant workers in the United States has, on the average, a positive effect on the financial status of the Social Security program,” Stephen C. Goss, the SSA’s chief actuary wrote.

Economist Ray Perryman of the Perryman Group in Waco, Texas, has studied the impact of undocumented workers on Utah and other state economies. He concluded that undocumented workers pay far more in overall taxes than they receive in benefits.

http://www.sltrib.com/sltrib/home/50881102-76/undocumented-immigrants-taxes-workers.html.csp

[I AM NOT THAT GUY 5,715]

THE NATIVES ARE THE FREELOADERS

[Gary and Alla 3,694]

THE NATIVES ARE THE FREELOADERS

But how can we pay for the native Freeloaders when the resources get allocated to the illegal slave labor force?

[I AM NOT THAT GUY 5,715]

But how can we pay for the native Freeloaders when the resources get allocated to the illegal slave labor force?

[Gary and Alla 3,694]

You want to continue the practice of an illegal exploited slave labor force?

[Bad_Daddy 2,209]

Anyone that thinks illegals pay their fare share are either brain dead, retarded, or a little bit of both. Defending illegals is like trying to defend Hitler. It just isn't happening.

http://www.frugal-cafe.com/public_html/frugal-blog/frugal-cafe-blogzone/2011/04/15/sickening-70-of-texas-illegal-alien-families-receive-welfare-tied-with-liberal-new-york-california/

Sickening: 70% of Texas’ Illegal Alien Families Receive Welfare, Tied with Liberal New York & California

Thirteen years after Congress overhauled the American welfare system, 57 percent of immigrants with children — those in the country legally or not — use at least one government, welfare program according to a report released Tuesday by the Center for Immigration Studies.

In comparison, 39 percent of native-born Americans with children are signed up for welfare, the report found.

In Texas, 54 percent of legal immigrants and 70 percent of illegal immigrants receive welfare assistance, with illegal immigrants generally receiving benefits on behalf of their U.S.-born children, according to the study, written by a think tank that favors reducing immigration into the U.S.

Overall, Texas tied with California and New York for the second highest immigrant welfare rates behind Arizona.

We should note that the study takes an expansive view of what constitutes a government welfare program, so programs such as reduced-price school lunches for low-income students are classified as welfare, according to CIS’ methodology.

Texas showed 61 percent of households headed by an immigrant utilizing at least one program compared to the 42 percent of Texas natives on welfare.

Surprise, surprise; Census Bureau data reveals that most U.S. families headed by illegal immigrants use taxpayer-funded welfare programs on behalf of their American-born anchor babies.

Even before the recession, immigrant households with children used welfare programs at consistently higher rates than natives, according to the extensive census data collected and analyzed by a nonpartisan Washington D.C.

group dedicated to researching legal and illegal immigration in the U.S. The results, published this month in a lengthy report, are hardly surprising.

Basically, the majority of households across the country benefitting from publicly-funded welfare programs are headed by immigrants, both legal and illegal. States where immigrant households with children have the highest welfare use rates are Arizona (62%), Texas, California and New York with 61% each and Pennsylvania (59%).

The study focused on eight major welfare programs that cost the government $517 billion the year they were examined. They include Supplemental Security Income (SSI) for the disabled, Temporary Assistance to Needy Families (TANF), a nutritional program known as Women, Infants and Children (WIC), food stamps, free/reduced school lunch, public housing and health insurance for the poor (Medicaid).

Edited December 27, 2011 by Why_Me