Psychiatric Patients Face Long Wait Times As ERs Aren't Equipped To Handle Them

Published: Friday, November 25, 2016 - 5:00am
Updated: Monday, November 28, 2016 - 2:18pm
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(Photo by Jimmy Jenkins - KJZZ)
Many uninsured patients turn to emergency rooms when they are having a psychiatric crisis.
(Photo by Jimmy Jenkins - KJZZ)
Banner Goldfield Medical Center in Apache Junction
(Photo by Jimmy Jenkins - KJZZ)
Dr. Clifford McNaughton diagnoses behavioral disorders in patients in Apache Junction from his office in Iowa via tele-sync.
(Photo by Jimmy Jenkins - KJZZ)
Dr. Robert Porter is the ER director at Banner Goldfield Medical Center. He says wait patients seeking psychiatric care in the emergency room can often go for hours before they can be properly diagnosed.
(Photo by Jimmy Jenkins - KJZZ)
Banner is constructing a new Behavioral Health Hospital on their campus in Scottsdale. The hospital cost more than $36 million and will have 96 private in-patient rooms.

Each year, about 36 million people in the United States experience a mental-health disorder. For some of us, this might mean dealing with depression. But for others, a behavioral-health problem can come in the form of a psychiatric emergency, which can lead them to the emergency room.

Dr. Robert Porter is the ER director at Banner Goldfield Medical Center in Apache Junction. He has eight beds for emergency patients, but they’re often filled by mental-health patients waiting to be diagnosed by a specialist.

“Some of them are suicidal, some people actually have schizophrenia or psychotic episodes where they just can’t take care of themselves," Porter said. There’s no psychiatrist on site at Banner Goldfield — and they are not alone.

Behavioral Health Providers In Short Supply

According to Kaiser Health, 48 states are designated as Health Professional Shortage Areas. This means they don’t have enough mental-health practitioners to meet demand.

According the same research, Arizona has one of the largest shortages in the country. The state is more than 200 providers shy of what experts say it needs. Porter says mental-health patients sometimes end up waiting hours — even days — in the ER for a diagnosis, which can exacerbate their already fragile condition.

“It can be very frustrating for them," Porter said. "That would drive me crazy to be in a room, in the bright lights that we have and not getting the care that they need.”

It’s frustrating for Porter, too, because while he watches psychiatric patients go without care, his other patients build up in the waiting room.

Nowhere Else To Turn

Dr. Renee Hsia is professor of emergency medicine and works at an ER in San Francisco. She says data from the past decade shows psychiatric visits to ERs have gone up by 55 percent and wait times have skyrocketed as well.

“What happens is that ERs have become the de facto dumping ground for psychiatric patients," Hsai said,  "which has ripple effects for non-psychiatric patients as well.”

She says market conditions are a major contributing factor. Many mental patients who turn to the ER for treatment are uninsured or are on Medicaid. "Because Medicaid tends to be a low-payer — they have low reimbursement rates — a lot of psychiatrists may not even want to accept them and so it’s hard to get these patients placement.”

Looking For Solutions

One way to treat patients faster is through what are known as tele-psych appraisals. Dr. Clifford McNaughton is a psychiatrist sitting in his office in Iowa, but through a video kiosk and a really fast Internet connection, he can evaluate patients here at Banner Goldfield in Apache Junction.

He says he approaches a lon- distance diagnosis in the same manner as if he were bed side. "First I just introduce myself and explain what the purpose is," McNaughton said. "I just want to understand more about what their situation is, why they had to end up at the emergency room.”

McNaughton can then work with the ER physicians on a treatment plan and refer patients to the proper service provider.

But even after the diagnosis, demand for beds still outpaces supply.

So much so that Banner Health is building a new behavioral-health hospital. They’re expanding their existing campus in Scottsdale.

Banner Behavioral Health CEO Brian Beutin says about 16,000 mental-health patients show up in Banner’s ERs every year. The new behavioral-health hospital will be able to handle emergency evaluations as well as provide longer in-patient care.

“The Phoenix market is tighter," Beutin said. "There’s just less beds here for individuals that need them and we run a very high occupancy.”

The new hospital will have 96 private, in-patient rooms and cost more than $36 million.

Dr. Gagandeep Singh is the chief medical officer. He says the new space will provide an opportunity to conduct more thorough treatment, to keep patients from having to return again and again for deeper, underlying problems.

“Somebody who’s got significant depression with a coexisting substance use problem, that’s a separate cohort of patients where you can really customize their treatment," Singh said.

After a few days to a week, patients can transition to outpatient services and get back to their lives. “These are all people who could be any of us," Singh said. "These are people that are our family members and our friends, who happen to be in a crisis.”

The new behavioral-health hospital will be open next year. Singh says it will be a place where patients can feel safe and get well.

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