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In Psychiatric Emergencies, Emergency Rooms Not Always Safe

Communities need specially-designed psychiatric emergency departments. Private insurance companies should provide more and better community care for persons with psychiatric problems, and more community alternative programs for persons in emotional distress should be developed.
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Last week, a 32-year-old woman shot herself to death in an emergency room in Silver City, N.M. at Gila Regional Medical Center. Police -- who were called by the mother, who reported that her daughter was suicidal and that she had a loaded gun -- took the suicidal woman to the hospital emergency room. One hour later, after being searched, stripped of her clothes, and left alone in a room, the woman pulled out a loaded gun, pointed it at her head, and pulled the trigger.

This is not the first time someone killed himself or herself in a hospital ER. In September, a man shot himself to death outside of an emergency department in Wichita, Kan. In August, a man in Stillwater, Okla. committed suicide in the emergency department restroom.

Had these individuals instead gone to a psychiatric emergency room, or one of a few (in the U.S.) specially designed and staffed, non-clinical settings for persons in emotional crisis, their deaths may have been prevented. In the case of psychiatric emergencies, emergency rooms are not always safe.

Often, upon entry to the emergency department, persons experiencing psychiatric emergencies are stripped of their clothes and belongings and put in a "safe room" with a staff member stationed nearby, to (hopefully) ensure that they do not harm themselves. This system obviously failed at Gila Regional Medical Center last week.

Hospital emergency departments are sterile, clinical, loud, and stimulating environments filled with persons with traumatic physical injuries. ER staff, including nurses and doctors, are often less equipped and less trained to handle patients who are suicidal than they are victims of motor vehicle accidents, or sufferers of chest pain. Most ER personnel have enough training to assess persons in emotional distress and call in mental health providers, but until that provider arrives, the patient merely waits.

Little to no treatment is rendered during this "holding" time. It can take several hours before psychiatric service providers arrive. Patients who are already emotional distressed and at an extremely low place often become worse. For the New Mexico woman, the result was lethal.

Surely, persons who are suicidal and intent on killing themselves and who wind up at a general hospital emergency department should be safe. According to nurse researcher Dr. Ann Mitchell and colleagues, a suicidal state is in fact an emergency and therefore should be treated as such by emergency department staff.

Yet in today's general hospital emergency departments, by the time a psychiatric nurse, psychiatric social worker, or someone else with qualifying expertise meets with the person who is suicidal, the person is often more upset, lonely, cold, hungry, and still suicidal and/or depressed. The person experiencing unusual phenomena, such as one who hears voices, may be worsened by this environment, too.

These persons are well aware of the treatment that they will receive in the hospital ER, but they have no other options.

Often, mental health crises occur outside of normal business hours (9-5, Monday through Friday). Even if the person sought help during business hours, the chance that a counselor or therapist could see them immediately is slim to none.

Therefore, when persons with mental health issues experience distressing thoughts of suicide, or panic levels of anxiety, the only place to turn is the hospital emergency department.

If the person in emotional distress in the emergency department is found to be in need of admission to a psychiatric unit, due to the shortage of psychiatric beds (again, more evidence of a broken mental health care system), the person might stay in the emergency department as a "boarder" for two to three days.

Emergency department visits and the boarding problem includes children and families, too. Can you imagine if you and your depressed and suicidal child had to sit in the emergency department waiting for three days before receiving any treatment?

So, what is the answer?

Communities need specially-designed psychiatric emergency departments. Programs like the Comprehensive Psychiatric Emergency Program (CPEP) in Syracuse, N.Y. are leading the way. But clearly, we need more.

Hospitals with general emergency departments need to improve the training that emergency department staff members receive. Private insurance companies should provide more and better community care for persons with psychiatric problems, and more community alternative programs for persons in emotional distress should be developed. If emergency rooms are places intended to save lives, they need to provide safer options for all the patients who come through their doors.

For more by Mona Shattell, click here.

For more on mental health, click here.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.