Rena Dubin at home during dinner with with her children Mia Dubin, Sophia,… (Linda Davidson/The Washington…)
One day in October, Rena Dubin got a call saying her 15-year-old daughter, Mia, who has Asperger’s syndrome and an anxiety disorder, had a panic attack so severe it caused her to run from her school building in Reisterstown, Md., and toward a busy road.
Confused and delusional, Mia was taken to Northwest Hospital in nearby Randallstown, the closest emergency room, where her mother hoped she would be swiftly transferred to a hospital that accepts adolescents for psychiatric inpatient treatment.
Instead, they waited. For nearly 24 hours, Mia lay on a gurney in Northwest’s emergency department. Finally giving up, the Dubins checked Mia out and drove her to Johns Hopkins Hospital. There, they waited in the emergency department for another day until Hopkins staffers tracked down an inpatient bed for Mia at Children’s National Medical Center in Washington.
“We just felt like we were in a holding pen,” Dubin, who lives in Columbia, said. “I was the one taking care of her in the ER, but the whole reason we brought her to the hospital is because we feel like we need help.”
The Dubins’ experience is an increasingly common one nationwide for psychiatric patients. The “boarding” of mental health patients in hospital emergency departments is a widespread problem that experts say is on the rise, in part because of cutbacks in inpatient hospital beds.
As states trimmed their budgets in the economic downturn, resources for mental health patients were among the casualties. Twenty-eight states and the District reduced their mental health funding by a total of $1.6 billion between fiscal 2009 and 2012.
Virginia, for example, eliminated funding for 19 acute care beds at the Northern Virginia Mental Health Institute in Falls Church in 2010, reducing the total from 129 to 110, though 13 have been restored through temporary funding. Restoring all19 beds permanently would cost $1.4 million a year.
Maryland lost 145 — or 12 percent — of its public psychiatric beds between 2005 and 2010, and Virginia lost 252 of its beds, or 15 percent, according to a 2012 report by the Treatment Advocacy Center, a nonprofit mental health group. The nonprofit says Maryland and Virginia have a “severe” bed shortage, with 12 to 19 beds per 100,000 people. The District wasn’t part of the report, but its mental health department said it increased its bed count by about 20 percent over the past three years, in large part because of the reopening of St. Elizabeths Hospital.
Meanwhile, more and more people are turning to emergency rooms for health care nationwide. ER visits increased by 32 percent from 1999 to 2009, and overall ER wait times for all sorts of ailments have also gone up, according to a Centers for Disease Control and Prevention report. Psychiatric patients make up 7 to 10 percent of emergency room visits, said a 2012 study in the Emergency Medicine International journal.
For many patients suffering from psychiatric crises, this translates to longer waits in emergency departments, where they receive no treatment for days — and sometimes weeks — while social workers try to chase down open spots in psychiatric wards, doctors said.
Jeff Sternlicht, chairman of emergency medicine at Greater Baltimore Medical Center, said that years ago patients stayed in emergency rooms only a few hours but that now the average time for a transfer is 15 hours — and some stay as long as three days.
Almost every day, patients who are suffering from hallucinations or who have attempted suicide flood Sternlicht’s emergency department. One patient had to be physically restrained because he kicked and punched emergency room nurses during a psychotic episode, Sternlicht said.
“The ER department is designed for acute care,” Sternlicht said. “It’s far from the ideal place to be if you’re a psychiatric patient.”
Patients who have disabilities or special needs, conditions that frequently occur with mental illness, are especially hard to place. Joel Klein, vice chairman of the emergency department at Baltimore Washington Medical Center in Glen Burnie, said that anecdotally, the incidence of boarding has risen at his hospital in recent years, particularly for patients who require an inpatient room with grab bars, specially trained staff or other accommodations.
“Those patients often stay for multiple days waiting for a bed,” he said.
Insurance coverage, which sometimes pays for inpatient treatment at only certain hospitals, further complicates matters. Heather Carpenter of Baltimore rushed her 15-year-old son to Medstar Franklin Square Medical Center in that city when he attempted suicide in May. But even though Franklin Square had beds available, he was boarded overnight because her insurance network included only hospitals with unavailable beds.