Doctors Hope New Mental Health Care Funds Ease Crisis, USA

Main Category: Mental Health
Article Date: 20 Dec 2007 - 3:00 PDT

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Often the highest-level, immediately-available care a person suffering a mental health crisis can receive is at their local emergency room (ER). For these psychiatric patients, the ER is a destination of last resort - other than jail. Texas' funding for psychiatric care is insufficient, physicians say, causing huge gaps in patient care. The situation is about to improve however, and not a moment too soon, according to physicians of the Texas Medical Association (TMA).

Psychiatric patients need ongoing care to help them through life. Without it, often patients can fall into crisis. Due to tight state budgets, these patients have few places to go. "What we had been hearing was emergency rooms are clogged; jails are clogged; state hospitals are full," says Joe Vesowate, Texas Department of State Health Services' (DSHS) assistant commissioner for mental health and substance abuse services, in the December Texas Medicine magazine.

Although the ER is not ideally suited to treat psychiatric patients' specialized needs, scores of psychotic patients wind up there. Emergency rooms have to take all patients who arrive through the doors.

"We're seeing a significant problem of patients with psychiatric disorders," arriving in the two hospitals' emergency centers where Arlo Weltge, MD, a Houston emergency medicine physician, treats patients. "It is a daily event." The unstable patients awaiting transfer to an appropriate mental health facility clog the ER and create a crowding bottleneck for any patient showing up with fractures, cuts, or heart attacks. For mental health patients the wait is often 12 hours to several days.

Emergency rooms are packed with families, children, and the elderly - people who all are sick. Mix in someone going through a mental health crisis, and it becomes uncomfortable for all. "It is pretty horrific at times. Screaming, yelling, emotionally distraught, not really comprehending what's going on with them," describes Dr. Weltge about psychotic patients.

Just like everything else in Texas, the mental health patient population is large. More than 4.3 million Texans have some form of diagnosable mental health disorder, yet Texas ranks 47th for mental health spending per capita. DSHS anticipates 47 percent more adults and 195 percent more children will need mental health crisis intervention by 2009.

In addition to the patients' suffering, everyone pays a price. The economic impact of mental illness is costing the state and local governments more than $1.5 billion per year. Include lost productivity due to mental illness, and the number climbs to $16.6 billion.

"We all recognize we are at risk for a motor vehicle accident, but we or someone we are very close to is always at risk of a mental health problem [too]," he says. Common triggers include loss of a loved one or other emotional events, substance abuse, violence, or the patient simply running out of medication that helped to manage his or her condition.

Although common, psychiatric illnesses carry stigma and receive less attention and funding than other medical problems, and this upsets Gary L. Etter, MD, a TMA physician leader. "If you look at it from a neuroscience standpoint, it is a medical illness, too. I do not see the difference between an impaired heart vs. an impaired mind. What is the difference? It's very frustrating," says the psychiatrist, who chairs the Federation of Texas Psychiatry.

Some help is on the way. The Texas Legislature appropriated $82 million this year for mental health services for 2008-09. The money will beef up crisis services in Texas. "This initiative has the potential to dramatically improve the provision of psychiatric services in Texas, and represents a major milestone in the history of psychiatric services in our state," says Dr. Etter, who served on the state's Crisis Services Redesign Committee, which advocated for the improvements.

The first steps - some already taking place - are to help local communities install and improve mental health crisis hotlines, mobile crisis units, crisis stabilization units, and in-home psychiatric services for children. Through the crisis hotlines and mobile crisis units, every Texas county will have basic crisis response resources. The goal is to provide continuity of care for patients and adequate safety nets if they fall. Funding will focus on bringing underserved areas up to par with the rest of the state, and matching funds when local communities invest in psychiatric emergency and outpatient care.

Rural Texas authorities should see improvements over their current routine. Typically sheriff deputies must transport psychiatric patients to the nearest appropriate care facility - often taking an entire day away from local law enforcement to do so. This adds up. Dr. Etter says the state of Texas has been paying counties approximately $3.4 million per year just to transport psychiatric patients. "If a system doesn't provide all components of treatment, then it usually ends up costing more. It ends up being like a revolving door," he says.

Dr. Weltge welcomes the improvements in patient care. "Ideally if [mental health patients] can be managed before they get in a crisis, they can maintain a reasonable semblance of their life," he says.

"I'd just like to see improvement for our patients so they have access to care - equal across all areas of our state," Dr. Etter adds. "All Texans will win if this is implemented correctly."

His hope is that the improvements will lead to better continuity of care, and reduce preventable patient trips to the local emergency room - or jail.

TMA is the largest state medical society in the nation, representing more than 42,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA's key objective since 1853 is to improve the health of all Texans.

http://www.texmed.org