Guest Commentary: Fixing the mental health bottleneck in California
Image: Vintage California, Calsidyrose, FlickrCommonCreative
Emergency departments in California have become too crowded, and people are waiting too long for care. As an emergency doctor, I want patients to come see me when they think they are having an emergency. We all deserve to receive prompt, quality care, but right now, it’s all too common to be stuck in a waiting room, scared, in pain, or possibly getting worse. There are many myths and misconceptions about ER crowding and long wait times, but runny noses and sprained ankles aren’t the cause. What if I told you that a broken mental health care delivery system is a big part of the problem?
I’m talking about so-called “5150” holds, which are named after the section of the Welfare and Institutions Code in California law that authorizes an involuntary 72-hour detention for an individual who is believed to need mental health services in order to protect themselves and others from harm. While the intent of the law is to protect the public and the patients, the reality is that the antiquated laws governing involuntary detention keep many people with mental health issues from getting the timely treatment they need.
This is a big issue. Across California, there are an estimated 800 individuals being held each day in hospitals as a “5150.” Patients come to me and my colleagues in the emergency department when they are suffering a mental health crisis, and we are happy to take care of them. What frustrates me is that after I have done my medical evaluation and initiated stabilizing psychiatric care, I can’t get my patients the next level of care that they need in a timely manner. Research indicates that approximately 70 percent of these patients don’t need to be transferred to a psychiatric hospital bed. Instead they would be better served through community-based services, but an outdated law stands in the way of my being able to release that person back to their family and their usual caregivers. The current system fails the mental health patients I serve: they wait in the ER, sometimes for several days, for the care they deserve. It also fails the entire community because holding these patients in our emergency departments ties up precious beds so that other patients who have come to us for treatment must endure longer wait times.
Emergency physicians spend at least three years beyond medical school in a residency program. Emergency medicine residency includes extensive education and a rigorous training experience that teaches us about all the other specialties, such as cardiology, obstetrics, surgery, internal medicine, pediatrics, neurology, orthopedics and psychiatry. We are specialists in identifying lower-risk patients and treating them on our own, as well as determining which higher-risk patients need to see another specialist.
Not every patient who comes to the ER with chest pain needs to see a cardiologist. Not every patient with severe headaches needs to see a neurologist, nor does every patient with a broken bone need to see an orthopedist. Likewise, not every patient who comes to the ER with behavioral health symptoms needs to see a psychiatrist. My specialty’s residency training makes me uniquely qualified to decide what level of care a patient with behavioral health symptoms needs, and my patients can rely on me to direct them to that level of care without having to wait in the ER for hours, and often times days, for another health care professional to start that process. My cardiac patients don’t have to wait, my obstetrical patients don’t have to wait; why should my patients with mental health needs suffer this delay of care?
To begin to fix the problem, Assemblyman Sebastian Ridley-Thomas, D-Los Angeles, has authored AB 1300. His bill would give ER doctors, like me, throughout California the clear authority to determine whether a 72-hour hold is needed. In my ER, having the ability to authorize a hold would mean I could get a patient to the inpatient psychiatric care they need many hours, and sometimes days, sooner. It would also mean I could get a patient home to their family or to needed community-based mental health services much sooner. This will speed mental health treatment for those who need it, and also help clear the logjam in my ER for my other patients facing emergencies.
Recently passed laws are providing funding for much-needed community-based crisis stabilization and crisis residential services. The community-based mental health infrastructure is beginning to be rebuilt. These new treatment opportunities will also free up space in much-needed inpatient psychiatric treatment facilities. Unfortunately, without AB 1300, my patients will continue to wait days on end in the ER before they can access those services. Removing barriers to treatment for mental health patients will help remove barriers for all who seek treatment in the ER.
Original article published by the Los Angeles Daily News