Sunday, Nov. 08, 2009

Psych patients stuck in emergency rooms

RALEIGH, N.C. -- Across North Carolina, mental patients are routinely languishing for days in emergency rooms ill-equipped to care for them, waiting for a bed to open at one of four state-run psychiatric hospitals.

Often, they pass the time handcuffed or sedated. Law-enforcement officers assigned to guard patients whose illness makes them prone to violent outbursts have occasionally resorted to using Tasers to shock them into submission.

Lanier Cansler, the state's secretary of health and human services, plans to ease the strain by paying private hospitals with taxpayer money to admit and treat more mental patients, especially those who don't qualify for Medicaid.

But a survey the department conducted of nine community hospitals raises questions about whether many medical facilities, especially those in rural areas, are capable of taking on that responsibility.

North Carolina tried to reform its mental health system in 2001 by downsizing state hospitals and paying private companies to care for those in outpatient clinics.

Nine years later, the reform has had the opposite of its intended effect. Programs that were supposed to save taxpayers money wasted more than $635 million, according to a recent legislative audit. Meanwhile, demand for state hospital beds has soared.

In the first eight months of this year, the state hospitals placed more than 3,700 patients seeking help on waiting lists because of the lack of available beds, according to the Department of Health and Human Services.

Despite the crisis, the state budget Gov. Bev Perdue signed in August cut $155million from the state's mental health system, resulting in the loss of 354 jobs at state hospitals. At Cansler's urging, $12million was allocated to pay for adding about 100 psychiatric beds at community hospitals - an average of one bed per county.

The money will go to pay for small units of eight to 10 beds each in a handful of medical hospitals across the state. The secretary hopes more money for the initiative will be available in the future, as the economy improves.

"We're returning to really what was the original intent of reform," said Cansler.

The bureaucracy

The secretary said he recognizes, however, that it will take far more than the 100 beds funded to ease the crush of patients seeking admission to state hospitals. And there are questions about whether hospitals in parts of the state where the need is greatest will participate.

Many of North Carolina's small community hospitals far from urban centers don't have access to psychiatrists or other professionals trained to help people with mental illness, especially those who might become violent, according to the health and human services survey.

Emergency room staffs at two of the nine hospitals reported multiple incidents of disruptive patients being Tasered by law officers in the last year.

All the hospitals surveyed, including Raleigh's WakeMed, reported an increase in the number of psychiatric patients over the past six months, a trend attributed to the weakened economy and shrinking options among the very out-patient treatment programs that were supposed to ease the demand on hospitals under the reform plan.

And when those at the community hospitals contact the government-run facilities for assistance, they said they are too often faced with rude state workers who use bureaucratic procedures purposely to delay admissions, according to the survey report.

Urgent phone messages are sometimes not returned for as long as 12 hours, and it is impossible to get someone admitted to a state facility during nights or weekends, when the need is often most acute.

'Crazy' cuts

The report, obtained by The News & Observer and The Charlotte Observer through a public records request, is far more frank and unvarnished than is typical for a government-produced document. Michael Lancaster, the chief of clinical policy for the state mental health system, described it as raw data intended for use by an internal workgroup.

Rep. Verla Insko, a Democrat from Chapel Hill who co-chairs the state's legislative oversight committee for mental health, said the survey identified problems that must be addressed if the system is to work.

Insko has heard of patients waiting in emergency rooms as long as 10 days and said the deep cuts to community services made in this year's state budget are "crazy."

"We should act quickly to ensure prompt and courteous communications between agencies and give priority at our state institutions to the most severely ill or violent patients," she said. "The overuse of emergency departments will go on as long as we fail to provide adequate services."

Ann Akland, president of the Wake County chapter of the National Alliance on Mental Illness, said she was horrified to hear that patients suffering psychotic episodes are being Tasered in emergency rooms.

"If this were happening to animals, people would be outraged," Akland said.