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Posted: October 12, 2008 5:00 a.m.

Mental patients strain emergency rooms

Failure of Ga. mental health hospitals creates backlog

 As the result of the crisis in the state’s psychiatric hospitals, Newton Medical Center’s emergency room has become very crowded of late as mental health patients wait for placement in Atlanta.

On a recent Thursday night, 13 mental health patients were in the ER at the same time waiting for placement at the Georgia Regional Hospital at Atlanta, the state mental health hospital where patients from metro Atlanta are typically sent if they do not have the insurance to pay for a private care facility.

"This is a new phenomenon for our emergency department and it requires taking up beds for these mental health patients," said Barbara Valentine, NMC assistant administrator in charge of patient care services.

Valentine said a backlog in the number of mental health patients throughout the Atlanta area waiting for beds to become available at GRH has resulted in NMC having to hold mental health patients much longer than they would normally.

"We are certainly not a mental health facility. We do not have the resources," Valentine said. "We are very interested in making sure that their care is safe but the sooner we can get them out of here, the better it is for that patient."

The overflowing of NMC’s emergency department has been spurred by the much publicized failure of the state’s mental health hospitals, which are now being investigated by the U.S. Justice Department for a large number of patient deaths over the years that were first brought to light through an investigation last year by the Atlanta Journal-Constitution.

"The mental health system in Georgia is both over-utilized and underfunded," said Kevin Bloye, spokesperson for the Georgia Hospital Association. "There’s not enough dollars in the system to meet the demand and there’s a shortage of health care workers so the system is really in a crisis stage."

The backlog of mental health patients is an additional burden on NMC’s already strained ER.

"Almost every night, every day we have mental health patients coming through," said Valentine.

Typically the Newton County Sherriff’s Office will bring individuals who they believe to be in need of specialized treatment to the hospital’s ER where they are medically cleared and given a mental health assessment. If the contracted counselor determines they need to be placed in a mental health facility, GRH is contacted and a bed reserved and they are transported from the ER, typically within the same day, according to Valentine.

"We would rarely have patients that would stay more than four to six hours," Valentine said.

Bill Dominicali, clinical director for the ER, estimated that the hospital is now doing between 70 and 80 mental health evaluations a month.

In part because of the federal investigation into GRH and other state mental hospitals, a cap has now been placed on the number of patients that can occupy a mental health institution at any one time

Wait times are now much longer for mental health patients in need of placement. While they are waiting for a bed to become available at GRH, patients remain in the ER where they must be supervised at all times because of the threat they could pose to themselves and others said Valentine. Due to overcrowding, some patients have had to be moved to the radiology department.

"It’s difficult because if you move them, they have to have one-on-one care [and are] under total surveillance the whole time," Valentine said. "We have to place these patients in special rooms where they cannot harm themselves. We’ve had to hire extra security guards to sit outside those rooms."

Dominicali said the time mental health patients spend in the ER before a bed is found for them at GRH is now about 48 hours.

"It’s not a good situation for the patient and it’s not a good situation for us, especially when they’re having some type of psychiatric episode," Valentine said.

The backlog in mental health patients has meant there are times when there are not enough beds for the acutely ill coming into the ER Valentine said. A triage system to determine who the sickest patients are is in place but other patients that come in with a fever or a severe cold may have to wait a little longer than before for a bed, she said.

Maggie Shelby, deputy director for clinical services with the Gwinnett Rockdale Newton Community Service Board, said all GRN community mental health services have been affected by the problems at GRH. Psychiatric patients are also crowding into the ERs of hospitals in Gwinnett and Rockdale counties, she said.

"We’re sort of here at the ground level and we’re dealing with the issue that if there are no beds, folks can’t get in," Shelby said. "Emergency rooms can’t just turn somebody out especially if they have a legal requirement at that point."

"It’s a huge problem statewide, there’s no question about it," said Boyle of the Georgia Hospital Association. "Without the mental health issue, hospitals are already facing overcrowding."

Bloye said as the state’s population continues to increase so does the number of psychiatric patients needing specialized attention.

In August, Gov. Sonny Perdue announced a plan to reform the state’s mental health system that would include reorganization of state social services. The plan could also include the consolidation of mental health services and the privatization of some mental health hospitals, according to an article in the AJC.

The governor’s plan will need to be approved by the Georgia Legislature. Bloye said GHA has not yet taken a position on the plan.

"We’re awaiting more details on the plan for privatization," Bloye said.

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