Emer­gency room is not the best place in a men­tal health cri­sis

The Oklahoman (Sunday) - - METRO | STATE - BY MEG WINGERTER Staff Writer [email protected]­la­homan.com

The first time Laura brought her son to St. An­thony’s be­cause of a men­tal health cri­sis, the wait in the emer­gency room was seven hours — an eter­nity to some­one who was hal­lu­ci­nat­ing that some­one was try­ing to find and kill him.

“The whole ex­pe­ri­ence seemed dis­or­ga­nized and un­pleas­ant," she said. "The staff didn't seem par­tic­u­larly car­ing."

For Kelly, how­ever, the ex­pe­ri­ence was bet­ter. She said St. An­thony’s staff took her daugh­ter back quickly when she took her to the emer­gency room in a psy­chotic state.

“They told me what they were al­lowed to tell me and tried to be help­ful,” she said.

Nei­ther ex­pe­ri­ence is un­usual. When The Ok­la­homan asked peo­ple with men­tal ill­nesses and their loved ones for their sto­ries of seek­ing care in emer­gency rooms, it turned up a mix of re­lief and frus­tra­tion. In some cases, peo­ple de­scribed nearly op­po­site ex­pe­ri­ences at the same hos­pi­tal, per­haps re­flect­ing whether they had the bad luck to need help on a busy night.

Shelly Payne, spokes­woman for St. An­thony’s, said the emer­gency depart­ment does med­i­cal and men­tal health as­sess­ments when pa­tients come in with a psy­chi­atric cri­sis. Depend­ing on the re­sults, a per­son could be ad­mit­ted for in­pa­tient men­tal health or med­i­cal care, or dis­charged to out­pa­tient care, she said.

Mike Brose, ex­ec­u­tive di­rec­tor of the Men­tal Health As­so­ci­a­tion Ok­la­homa, said emer­gency rooms are set up to triage and treat pa­tients who are in im­me­di­ate phys­i­cal danger, so a per­son who is hav­ing hal­lu­ci­na­tions or thoughts of sui­cide but is phys­i­cally sta­ble may have a long wait. The un­cer­tainty can be trau­matic to a per­son in cri­sis, but the emer­gency room staff are stretched thin and not trained to fo­cus on men­tal health, he said.

“They will al­ways pri­or­i­tize some­one who’s hav­ing a med­i­cal emer­gency over a psy­chi­atric emer­gency,” he said.

Typ­i­cally, emer­gency rooms are lim­ited in what they can of­fer, be­yond shots of an­tipsy­chotic drugs. Hos­pi­tals that have men­tal health units can ad­mit pa­tients who agree to ac­cept care, or are in­vol­un­tar­ily com­mit­ted be­cause of danger to them­selves or oth­ers.

Pa­tients and fam­i­lies seek­ing help dur­ing a men­tal health cri­sis might have an eas­ier time if they can go di­rectly to a cri­sis cen­ter, though those aren’t avail­able in all parts of the state, Brose said. Even if there is a cen­ter nearby, po­lice still may have to take the per­son in cri­sis to an emer­gency room for “med­i­cal clear­ance” be­fore a men­tal health fa­cil­ity will agree to treat the per­son, he said.

Dr. Ja­son Bea­man, chair­man of psy­chi­a­try at the Ok­la­homa State Univer­sity Cen­ter for Health Sciences, says a task force in Tulsa is work­ing on re­duc­ing those vis­its.

The cur­rent setup doesn’t work well for the pa­tients who may have long waits, the po­lice of­fi­cers who have to stay with them or the emer­gency room doc­tors who al­ready have plenty of work, he said.

If pa­tients have signs of a phys­i­cal health prob­lem, such as chest pain, it’s im­por­tant to take them to an emer­gency room, but it’s not nec­es­sary as a rou­tine mea­sure, Bea­man said. Ide­ally, a nurse or doc­tor at a men­tal health fa­cil­ity would check vi­tal signs and or­der any nec­es­sary blood work, he said.

If a fam­ily does end up need­ing to go to an emer­gency room for a cri­sis, it helps to plan ahead, Brose said. If pos­si­ble, make a list of med­i­ca­tions and providers.

Jean Wil­liams, a vol­un­teer with the Na­tional Al­liance on Men­tal Ill­ness Ok­la­homa, also ad­vised fam­i­lies who have a loved one with a men­tal health con­di­tion to ed­u­cate them­selves about how the sys­tem works be­fore they need to use it.

Med­i­cal pri­vacy laws can make the process frus­trat­ing, be­cause doc­tors may not be able to re­port any­thing to fam­ily mem­bers, Wil­liams said. Fam­i­lies still can play an im­por­tant role, how­ever, by of­fer­ing con­text about the per­son’s con­di­tion, she said.

“Even though it can be frus­trat­ing to sit in a lobby for hours just hop­ing to talk to some­one, it is im­por­tant to show up at ev­ery step in the process,” she said.

Mike Brose, Men­tal Health As­so­ci­a­tion Ok­la­homa ex­ec­u­tive di­rec­tor

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