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Mental health emergency department visits outpace non-psychiatric episodes, study says

More than 65 million ED mental health visits reported, substance abuse behind 41 percent of them, results show.

Susan Morse, Managing Editor

Mental and behavioral health issues, including drug addiction, are becoming a major focus for healthcare providers and payers as a new study show patients needing psychiatric services are filling emergency rooms.

Hospitals often don't have the beds or the professional expertise to treat patients needing psychiatric care, according to a study released Monday during a conference of the American College of Emergency Physicians.

Three-quarters of emergency physicians responding to a poll of more than 1,700 ER physicians reported seeing patients at least once a shift who required hospitalization for psychiatric treatment. One-quarter, 21 percent, said they had patients waiting two to five days in the ER for inpatient beds.

[Also: Law will broaden access to mental health professionals, Medi-Cal coverage]

Only 16.9 percent of emergency room physicians reported having a psychiatrist on call to respond; 11.7 percent reported having no one on call to respond to psychiatric emergencies.

"The absolute number of psychiatric visits increased by 55 percent, from 4.4 million to 6.8 million between 2002 and 2011, far outpacing the growth of non-psychiatric visits," said Dr. Renee Hsia, author of one of the studies presented at ACEP16.

Of more than 65 million emergency department mental health visits reported, substance abuse comprised 41 percent of the visits; followed by anxiety at 26 percent; and depression at 23 percent, according to study author Suzanne Catherine Lippert, MD, of Stanford University.

[Also: Access to mental health treatment for the young can hinge on race, ethnicity]

"The emergency department has become the dumping ground for these vulnerable patients who have been abandoned by every other part of the health care system," Rebecca Parker, MD, president of the American College of Emergency Physicians, said in a released statement. "Virtually every emergency physician I know can report anecdotally about the surge in psychiatric patients filling their emergency departments waiting for care in the last year."

As providers already know, ER care is costly, as is treatment for mental health and substance abuse.

Expenditures on mental health and substance abuse treatment  reached $239 billion in 2014, up from $121 billion in 2003, according to the U.S. Department of Health and Human Services.

[Also: Minnesota Hospital Association study shows huge gaps in appropriate care for mental health patients]

Many behavioral disorders seen by physicians are at their root, coping mechanisms, according to John P. Docherty, MD, senior vice president and medical director of ODH, Inc., a provider of behavioral health analytics solutions.

"Many, many things affect health that we hadn't thought of within a narrow range of medicine," he said.

This includes lack of sleep. An estimated 10 percent of the population is dealing with chronic insomnia, Docherty said.

Stress can lead to a more costly behavioral health issue later on, and with about 20 percent of health determined by lifestyle, it's important to engage the patient as an active partner, Docherty said.

"People will do what you make easy for them," he said.

For instance, if people are asked to opt into a program, the response is low, while if they are asked to opt out, the retention rate is 82 percent.

"We're trying to figure out, how do we do that in healthcare," Docherty said. "Both hospitals and health plans need to look at it. It's what the thrust of population health management is about. You have to figure out what we know of core behavioral issues that are going to impact healthcare costs."

Congress has taken up the issue, passing the Helping Families in Mental Health Crisis Act in July. Lawmakers are expected to pass the  package of mental health reforms before the end of the year.

The Helping Families in Mental Health Crisis Act would provide more hospital beds for people dealing with a mental illness who  need short-term hospitalization.

It would also create a new federal position to oversee mental health, support grants for community health, assist with outpatient treatment, and allow state Medicaid managed-care programs to pay for short-term inpatient stays.

In addition, the bill would support training for more mental health professionals; help providers more easily track available inpatient beds; support a wide range of programs to combat suicide, improve screening for mental illness in children; and push to reduce incarceration of nonviolent, mentally ill offenders.

Twitter: @SusanJMorse