In a study of more than 1,000 emergency room patients at five general hospitals in Massachusetts, a team of researchers found that, compared with the typical ER patient nationwide, psychiatric patients:

• waited three times longer for care,
• had four times the rate of admission or transfer, and
• were 20 times more likely to stay at least 24 hours.

The researchers also found that patients with public health insurances were more likely to spend 24 hours or longer in the ER than those with private insurance (“Characteristics of adult psychiatric patients with stays of 24 hours or more in the emergency department,” Psychiatric Services, March 2012, available online only to Psychiatric Services subscribers or by fee).

Longer stays additionally were more likely among patients who were homeless, required transfer to psychiatric care elsewhere or required the use of restraints. Not surprising to us, the longest ER stays were in the two hospitals with the fewest inpatient psychiatric beds. The shrinking population of state hospital beds also was cited as a reason for longer ER stays.

The authors said psychiatric “boarding” in ERs contributes to ER crowding, reduces patient safety by preventing new patients from being seen, increases patient walkouts and reduces patient satisfaction with the ER experience.

To put the information in context, they said 124 million ER visits took place national in 2008 the – year of their study – and, of those, only  0.4% lasted 24 hours or more. Among the psychiatric patients they studied:

• the median stay was 7.6 hours vs 2.6 hours,
• the rate of hospital admission was 25% vs. 13.4%,
• and the rate of transfer to a different hospital was 37.5% vs. 1.7%.

Emergency psychiatric hospitalization is a consequence of not treating severe mental illness before it reaches an acute state. As long as court-ordered outpatient treatment options are overlooked, underused or rejected, hospitals can expect to see these numbers only grow worse.

To read news about the state of emergency in Virginia ER's, read " ‘Streeting’ of mental illness patients a problem in Virginia" (Washington Times, April 2).

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