Top of Mind: Mental health patients face rising wait times in ED in midst of COVID and statewide shortage of psych beds

WILMINGTON, N.C. (WECT) - The pandemic has exacerbated the already critical ER wait times faced by mental health patients in crisis.

It’s an issue that weighs heavily on the hearts of countless patients and families, and it’s also a problem that impacts healthcare costs for us all.

One in eight visits to the emergency room is related to mental illness or substance abuse, adding up to 12 million visits a year, according to NAMI.

CATCH PART 1 OF TOP OF MIND: FOCUS ON MENTAL HEALTH HERE

It’s been months since a young UNCW student was involuntarily committed after her depression spiraled out of control.

Involuntary commitment is a legal intervention used to get people care when they are deemed to be a danger to themselves or others. Once the papers are filed in North Carolina, law enforcement typically finds the person, then transports the patient to the hospital to be evaluated and placed in a psych bed at the proper facility.

Law enforcement was dispatched to the 20-year-old woman’s dorm room back in November after she tried to end her life by jumping off the roof of the building.

Her bruises have healed, but the emotional scars are still there.

She’s in therapy and has a job, but says she will never forget waiting in a dark room in the hospital emergency department for three days before a bed opened up at an inpatient facility.

“I heard people screaming outside, there were people sleeping in cots outside in the hallways. The whole experience in the hospital was just honestly very traumatizing,” said the student, who wished to remain anonymous. “I doubt I’ll ever have another suicide attempt or ever try to hurt myself again for the fear of having to go back.”

It’s a story psychologist Hillary Faulk Vaughan hears often. Some of her clients at Physician Alliance for Mental Health have conditions that require placement at state facilities like Cherry Hospital with much higher wait times.

“I believe the longest we had somebody waiting in the emergency room was a little over 30 days. We were working with the ER the very best we could to get them the help they needed. The involuntary commitment just kept re-upping,” said Hillary Faulk Vaughan.

The workflow for people waiting on mental healthcare is in some ways similar to going to the ER after you break your leg. It’s the job of ER staff to stabilize your leg then send you to a specialist like an orthopedic.

The difference is people with leg injuries wait at home for the specialist. If you’ve been involuntarily committed, you can’t go home. You’re waiting in the ER.

Staffing crunches, and emergency departments flooded with COVID patients have exacerbated already long wait times. It’s a perfect storm that drove wait times for a psych bed up from six days pre-pandemic to an average of eight days during the pandemic.

The core reason for the delays boils down to North Carolina’s critical shortage of inpatient care beds.

The Treatment Advocacy Center suggests it takes 50 psych beds per capita to adequately meet the demand of the community. In 2020, DHHS confirmed North Carolina had just 22.7 beds per capita.

The demand is even higher for facilities that allow patients that have a history violent behaviors, financial constraints, or complex medical needs.

The wait times are so long, it’s not uncommon for patients to stabilize enough for the involuntary commitment orders to expire and the person is discharged from the ER to the street, never having received any treatment.

“Emergency department staff does the very best they can to meet their needs within their capabilities and resources. Obviously they are not staffed nor trained to provide ongoing therapeutic, long-term psychiatric interventions. What they do is work on stabilization. They receive food, they receive medication, but you’re talking about pretty much being strapped to a bed. There’s no groups, there’s no therapy,” said Faulk Vaughan.

Advocates worry the lack of available psych beds is both a patient safety issue and a risk to ED staff as well. It all adds up to a high degree of need and limited resources.

”It’s so easy when things get hard is to point fingers, but what we know about this system is every step of the process, whether it’s an outpatient provider, whether it’s the emergency room staff, the inpatient psychiatric facilities — private or public — they’re staffed by individuals who care and are doing the very best that they can,” said Faulk-Vaughan.

The wait for those limited beds is a problem each link in that chain agrees needs to be fixed, including people, like the 20-year-old UNCW student, who have gone through the system themselves.

“I try not to place blame on anybody but if people who need — really need — help are being treated like that... I’m sure there’s cases just like mine where we were just in a bad spot and we just needed someone to help us back on our feet,” said the young woman.

In Thursday’s Top of Mind: Focus on Mental Health Part III we discuss what’s being done to help bridge the gaps and share details about one inspiring project kicking off this week in the Cape Fear region.

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