PEOPLE WITH mental illnesses tell painful stories about hospital emergency rooms. They say they have been stripped, restrained, isolated, mocked by hospital staff, or treated by doctors who paid more attention to their mental illness than to the physical ailment for which they sought care. The state Department of Public Health has verified cases of patients who have suffered excessive physical harm or been poorly monitored while placed in restraints.
These patients deserve better.
Many hospitals do provide good care. Boston Medical Center runs the state-funded Boston Emergency Services Team, which strives to keep patients with mental illnesses out of the hospital to begin with. Services include a call center and two off-site urgent care centers. Mobile teams visit facilities such as group homes. A family stabilization team goes into patients’ homes. And when a patient does need to visit the emergency room, the one at BMC is staffed with psychiatric clinicians.
But in more disturbing cases, fragile patients go into overwhelmed emergency rooms, creating a clash of competing needs. Anxious patients need highly skilled care. Overstressed emergency rooms may need more resources — including trained staff, money, and space.
Two bills filed this year looked for ways to improve patient care. One sponsored by Waltham Democrat Peter Koutoujian would have switched the job of licensing psychiatric emergency room beds from the Department of Public Health to the Department of Mental Health. But the bill hasn’t advanced beyond the committee stage. Another bill, filed by Representative Ruth Balser, a Newton Democrat, calls on DPH and DMH to work with clinicians and advocates to develop regulations for providing care to mentally ill patients in hospital ERs. The two departments would then jointly enforce the resulting regulations.
The Patrick administration objects. In a letter to Balser in September, DPH commissioner John Auerbach and DMH commissioner Barbara Leadholm both warned against a regulatory approach, even as they agreed on the need for improved care. The commissioners did organize a working group of advocates, hospital officials, state agency staff, and others that is scheduled to meet tomorrow.
To minimize needless suffering by some of the state’s most vulnerable citizens, the working group should hammer out a plan that reduces long waits in emergency rooms and creates more ways to help mentally ill patients avoid them altogether. Eventually, there should also be corresponding legislation that protects such patients with the power of state law.
Patients with mental illnesses should get care that preserves their health and dignity.
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