Our Turn: Emergency room is no place to treat mental illness

  • John Broderick is a former New Hampshire Supreme Court chief justice. AP

Published: 4/14/2016 12:10:09 AM

Imagine rushing an acutely ill friend or loved one to a local emergency room, having your worst fears confirmed by the doctor, and then being told that it could be days before they can be admitted to the right hospital for treatment because of a waiting list. In the meantime, the critically ill person is left in or near the emergency room receiving less than adequate care and treatment for several more days.

This is not a hypothetical situation; it is the tragic reality faced by many individuals with acute mental illness and their families in New Hampshire.

On March 1, there were 54 individuals in a mental health crisis who were being “boarded” in emergency rooms throughout our state. They included adults and children. For them and their families, adrift in a nightmare, it is a painful, frightening, humiliating and infuriating ordeal.

Sadly, it has been going on for more than four years and may be worsening, given these most recent numbers.

This unfortunate reality fails the patient who is experiencing acute mental suffering on many fronts – medical, ethical, moral and economic.

It is medically wrong because it delays treatment to reduce mental suffering and promote recovery. Treatment for mental illness, like other medical conditions, has a greater likelihood of positive outcomes the sooner it begins. And like other medical conditions, untreated mental illness can be fatal. Suicide is the second leading cause of death in New Hampshire for people between the ages of 10 and 34.

It is ethically and morally wrong to keep people who need involuntary admission to the New Hampshire Hospital stuck in a hospital emergency room.

While state law establishes due process and other legal protections within 72 hours of involuntary admission to New Hampshire Hospital, many people wait days before the 72-hour clock begins to run. It seems particularly uncivilized in the 21st century.

No other illness is treated this way in the American health care system.

Because of the shortage of critical care treatment beds for those at risk to themselves and others because of mental illness, it is ethically wrong to force hospitals, their emergency room and their dedicated medical and nursing staff to be left to hold/attend to someone who should not be in their care.

It is also economically unsound for people to languish in hospital emergency rooms for days because we have insufficient community capacity or inpatient beds.

As we know, emergency departments are one of the most costly hospital charges for patients and for hospitals to maintain. These individuals could receive more effective and less costly treatment in other settings.

The reasons for this situation are many, and the state of New Hampshire is trying to address them.

We need to stem the flow of people in an acute psychiatric crisis coming to our emergency rooms by enhancing care in their communities.

People with mental illness do better in their community and with family support. The state needs to redouble its efforts to adequately fund community mental health centers and to deploy mobile crisis response teams statewide. But when people do arrive in the emergency rooms diagnosed as a risk to themselves and others, we have an obligation to find them prompt and appropriate care at New Hampshire Hospital.

Jeff Meyers, our new commissioner of the Department of Health and Human Services, to his credit, convened an emergency meeting to discuss the wait list at New Hampshire Hospital. We know this is a concern for the governor as well.

Participants in the meeting included the governor’s office, mental health centers, hospitals, advocates, HHS and New Hampshire Hospital staff, and the attorney general’s office.

While we applaud this important step, New Hampshire desperately needs an updated and comprehensive strategic plan that addresses mental health services across the life span.

Once New Hampshire solves the wait list issue, which is causing great turmoil for people with acute mental illness and their families, we need to take a fresh look at the safety net and the assistance that New Hampshire provides to those afflicted with the emotional suffering of mental illness.

And we have little time to waste.

(John Broderick is a former chief justice of the New Hampshire Supreme Court. Ken Norton is the executive director of NAMI New Hampshire, the N.H. chapter of the National Alliance on Mental Illness.)


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