Psych ER Fills Gap in Mental Health Care
Oct. 20 -- Another casualty of a health care system in crisis, mental health hospitals across the country face widespread cuts and closings that have shrunk inpatient care, clogged emergency facilities, and diluted the quality of care available to the growing legions of uninsured.
Yet an unlikely bright spot shines in one of Southside Chicago's toughest neighborhoods.
Englewood — plagued by poverty, wracked by crime, and, according to former district police commander Maurice Ford, home to the largest number of mentally ill in the state — has only one hospital. That hospital, St. Bernard, boasts a specialized psychiatric emergency room, newly built in 1996, and featured on Nightline Monday night.
While the majority of the nation's psychiatric emergencies are handled in general emergency rooms, separate psychiatric ERs give uninsured patients direct access to care. Federal legislation enacted in 1986 — EMTALA, the Emergency Medical Treatment and Active Labor Act — bans any emergency facility from turning an uninsured patient away.
According to Mark Tryba, director of mental health services at St. Bernard Hospital, having "a separate ER for pysch patients really affords them the respect and dignity that all patients are entitled to."
A general emergency room can be a chaotic place for the mentally ill, but a specialized facility can offer them privacy and security hard to come by in a general ER, Tryba says.
Intended as a "pit stop" or elaborate triage to sort and funnel patients into a psychiatric hospital or back out into the world, the psychiatric emergency room increasingly plays the role of primary caregiver — most often to the uninsured, or to admitted patients awaiting transfer to shrinking psychiatric inpatient units increasingly unable to accept them. The busiest psychiatric ERs treat more than 7,000 patients a year.
Deinstitutionalization and the Psychiatric ER
Roughly one-third of community hospitals surveyed by the American Hospital Association (AHA) in 2001 reported offering psychiatric emergency services.
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