Patients wait days for beds

Imagine this:

A man with schizophrenia has gone off his meds. He's also high on cocaine and acting psychotic. He is taken to the Wake County mental health crisis center.

The psychiatrist on duty determines that yes, no doubt, this man needs immediate psychiatric intervention.

An involuntary commitment order is signed.

But first the man needs to be "medically cleared." He's sent next door to the emergency department at WakeMed.

Ostensibly, this should be a brief stop, a mere formality, before the patient is sent to a psychiatric hospital. But for about a third of the mentally ill patients being committed through WakeMed, that's not what happens.

Those patients sit -- not for hours, but for days -- waiting for a bed at a state psychiatric facility to open, according to WakeMed officials.

At the county's busiest hospital, 30 or more mentally ill patients a month are occupying emergency room beds, or observation rooms, pending admission to an appropriate psychiatric facility.

On average, they spend two or three days -- sometimes less, sometimes more -- waiting for that slot.

In a recent interview, Bill Atkinson, chairman and CEO of WakeMed, said that between January and October of this year, 689 "patient days" had been taken up by the mentally ill waiting for admission to a psychiatric facility.

According to a May 2008 report from the N.C. Hospital Association, "mental health concerns, including substance abuse, have reached the crisis point in North Carolina, and emergency departments are overflowing with these cases."

It is, in short, a disaster for everyone involved, including you and me.

"These are usually the toughest folks to place," said Dr. James Hartye, physician in charge of clinical care at WakeMed.

They don't have insurance and, as in the imaginary scenario described above, they are often the most severely mentally ill -- in crisis, with drugs or alcohol mixed in. As a result, they need constant monitoring.

"We have to plant a sitter with them 24 hours a day," said Amy Blackwell, who oversees doctor relations for the hospital.

If a sitter is unavailable, the person monitoring the patient is a hospital staffer -- or a police officer. Guess who foots the bill for that?

What's really sad, though, is that the mentally ill patients are stuck in an atmosphere that can exacerbate their problems. Many are agitated by all the noise and activity.

Dr. James Palombaro, president of Wake Emergency Physicians, put it plainly: "This doesn't serve the mentally ill person's needs."

Neither does it serve the public's.

When mentally ill patients are cooling their heels for days in the emergency room, the beds they occupy cannot be used by people who need immediate medical care. The hospital association report identified mental health issues as the "number one detractor of emergency care services" in this state.

Imagine this: A child has thrown up so many times, his skin is like parchment. An elderly woman has fallen and broken a hip.

They end up in the emergency room -- but there is no room. That bed, or examination table, is being occupied by someone who needs help from the state's mental health system.

That system, under constant pressure to shrink, once again comes up short.