08/20/07 — Mental Health Reform - Beds are not always available for inmates

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Mental Health Reform - Beds are not always available for inmates

By Matthew Whittle
Published in News on August 20, 2007 1:46 PM

When mental health patients aren't getting the treatment they need, whether it be therapy or medication, they more often than not end up in crisis. And whether that lack of treatment was because they were unwilling to help themselves, or because they couldn't navigate the system to find help, as the state's centralized mental health centers have divested themselves of services, the first place most patients and their loved ones in Wayne County now turn to is the Wayne Memorial Hospital Emergency Depart-ment.

It's an especially popular option at night and on weekends, and almost always, the patient is there involuntarily.

When a patient is brought for an involuntary commitment, that traditionally means he has threatened to hurt himself or others -- which in turn means that he must not only be treated for any medical injuries he might have sustained, but also evaluated from a mental health standpoint.

It's a process that, if everything goes well, can take several hours -- even longer if the patient arrives without involuntary commitment papers.

"If they show up at the emergency department without those papers, then we can't legally hold them and force treatment," explained Lloyd Smith, director of the hospital emergency department.

At that point, it becomes a waiting game with the patient occupying a bed in the already overcrowded emergency department.

It also puts a strain on local law enforcement agencies, especially if Cherry Hospital's beds are maxed out and the patient has to be transported to Butner, Dorothea Dix or some other private facility.

But for Smith, it's getting to that point of transportation that's the problem.

The emergency department was originally meant to accommodate about 35,000 visits a year. In 2006, it had more than 48,000.

And so, having patients there with mental health problems, whether they have a medical emergency or not, simply "means there is less room and at least one less staff member available," Smith said. "We have to try and protect the patient. Whether it's a nurse, a nurse's aid or a member of the hospital security team, somebody has to sit with the patient."

And that can be dangerous work.

"No broken bones or anything, but certainly there have been injuries like bruises," he said. "If, in our judgment, though, they are a danger to themselves or others, we will use hospital security to restrain them."

But without the involuntary commitment papers, they can't force the patient to stay at the hospital, and occasionally, some do decide to leave.

To get the involuntary commitment papers, someone, either a family member or law enforcement officer, must appear before a magistrate. For the Wayne County Sheriff's Office, handling two to three such cases a day, seven days a week, at four to five hours each, is nothing unusual.

But it is, said Wayne County Magistrate Bill Buchanan, a fairly simple, if sometimes long, process.

"We judge whether it's reasonable to issue a commitment order," he explained. "We send them to the doctor. We don't commit them. What we have to determine is whether they are a danger to themselves or others. It's something we take very seriously.

"When we do an involuntary commitment, we're basically taking the person's rights away."

Once those commitment papers are in order, the patient is then medically evaluated by the emergency department staff and an Eastpointe representative is called to assess the patient's mental health and begin the transfer paperwork.

By going to the magistrate first, Smith explained, people can help keep the system from getting bogged down and help the patients receive treatment in a more timely manner.

"We want to educate the public that if someone is a danger to themselves or others, they should go to the magistrate first and go through the legal system," he said.

He also explained that the hospital is not the only option for people needing help getting somebody committed. Any doctor in the state can process an involuntary commitment.

"The public doesn't have to use the emergency room," he said. "There's nothing specific in state law saying you have to use an ED for involuntary commitment."

But the reason people do, Smith continued, is clear -- it's the first place most people think of when someone reaches that crisis stage, especially now that there is no longer a true mental health center.

That's why, from January, 2006 to June, 2007, of the 1,081 people transferred out of Wayne's ED, 313 (28.95 percent) were there with a mental health problem.

And with those numbers comes an increased cost.

Hospital finance officer Rebecca Craig estimated that over the course of a year, the hospital likely spends about $100,000 a year to treat mental health patients -- much of which ends up being written off as either uncollectable bad debts or as charity.

But really, Smith said, the problem just comes down to the fact that neither the private provider network or Cherry Hospital is equipped to handle crisis situations, and there is no longer a centralized service point.

"Despite the rhetoric, when you dismantle the mental health system, you are, in essence, telling people to go to the emergency department for their mental health care," Smith said. "We want to be able to provide care to the public, and this puts a strain on that ability. We have been asked to do a task we feel is really a state and governmental responsibility."