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