ER Wait Times and Length of Stay for Psychiatric Patients Case Study - Paper Example

Psychiatry is a branch of medicine that focuses on the prevention, analysis, and treatment of mental and behavioral conditions. These conditions may be caused by genes (biological factors); experiences, for example, stress; history of abuse; brain injury; misuse of drugs; and exposure to dangerous chemicals while pregnant. Individuals with psychiatric problems suffer from ailments experience long-term feelings such as fear, sadness, hopelessness, anxiety, panic attacks, and suicidal thoughts. These may develop into severe problems like depression or mood, bipolar, personality, stress, post-traumatic disorders. People with psychiatric problems seek treatment and therapy from a specialist called psychiatrists (Moy et al. 2016). But most psychiatric patients are made to wait for terribly long periods in the Emergency room before they see a mental health professional. In this paper, using a hypothetical patient case, I will discuss the demographics, legal and ethical analysis and possible solutions to the prolonged period that psychiatric patient stays in the emergency room before receiving treatment.

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Sharon is a middle aged woman. She graduated from the University top of her class, and she landed a lucrative job in New York. Sharon was very social and had a handsome boyfriend, Mark. Sharon had been happy and contented with her life until she met Mark. Mark is a serial womanizer who has little regard for commitments. He was also a heavy drinker who likes to party late into the night. Marks habits affected Sharon negatively; she stayed late at night waiting for him. He came home very drunk. One day after two years of dating Mark raped Sharon at a knife point and walked out of her life. Sharon never told anybody about the incident, but it affected her performance in her job where she was demoted from a senior managerial position and eventually was fired. Losing the love of her life and her job Sharon was devastated. For a month she barely left her bed and couldnt find the energy to do anything other than cry. After two months she as severely depressed, she was not eating or sleeping. She had grown thin, weak and attempted suicide thrice. Her friends took her to the hospital. On arriving at the hospital, Sharon was held in the emergency room for ten hours before she left. This was because there were no psychiatric on duty to attend her. It had taken three days before she found an inpatient bed. Sharon was diagnosed with Post-traumatic stress disorder (PTSD), severe depression and malnutrition.

Thousands of psychiatric patients in the United States can relate to Sharons case. A survey conducted on 1,700 emergency physicians by the American College of Emergency Physicians (ACEP), 48% of doctors reported that at least one mental illness patient per day is boarded in the emergency room for long periods waiting before receiving treatment (American Psychiatric Association, 2016). It was reported that 21% of these psychiatric patients wait for up to two to five days. The majority of the doctors reported that children with mental disorders remained in the Emergency room for increased period compared to adults. 16.9% of the doctors stated having a psychiatric on duty to attend the psychiatric cases while 11 % have no one on duty to attend the cases (Castellucci, 2016). More than 10% of the doctors said to have 6 or more psychiatric patients waiting for inpatient beds on their last shifts (Castellucci, 2016).

Recent surveys conducted found that patients with bipolar disorder, psychosis, dual diagnosis, multiple psychiatric diagnosis, and depression had increased chances of spending more than 24 hours in the emergency room. The study found that 21% of psychiatric patients, as opposed to 13.5% of medical patients, required admission to the hospital. 11% of psychiatric patients versus 1.4% patient of medical were transferred to other facilities to seek advanced or specialized treatment. 22% of psychiatric patients were uninsured, and 4.6% returned to the emergency room within 72 hours of being discharged. Additionally, for the last couple of decades, emergency rooms have seen increasing numbers of people with psychiatric disorders. Figures show that psychiatric visits grew by 55 percent, from 4.4 Million to 6.8 Million from 2002 to 2011. They have overtaken the number of medical visits (University of Pennsylvania School of Medicine, 2016). A lengthy stay in emergency rooms is not only an inconvenience to the hospital in general but also has an adverse effect on the patient conditions and causes an increase in suffering.

Sharons psychiatric condition cannot be treated, medical doctors. She had to wait for the medical doctors to request a psychiatric to attend her hence increasing the length of wait for her and other psychiatric patients. This is because her condition is caused mostly by problems of thinking, feeling or behavior. In everyday speech and medical circles, illness refers to the presence of organic pathology. Even though organic fault causes some psychiatric disorders, most cannot be classified as illness or disease. Unlike medical diseases like Cancer, AIDS, and diabetes there are no scientific tests to verify the existence of psychiatric disorders such as Bipolar Disorder, Attention Deficit Disorder and depression (Peters, 2013). Efforts by psychiatrists to prove mental illness as biological brain conditions such as Chemical imbalances have failed (Peters, 2013). Sharon was healthy until she lost her job and lover, both losses led to chronic stress and negative behavioral changes which resulted in depression. Due to not eating she developed real illness such as malnutrition. Her malnutrition was treated by a medical doctor through the use of drugs and dietary supplements while psychotherapy treated her depression and PTSD. Her psychiatric used Cognitive Therapy and Exposure therapy for three months to help her overcome the PTSD and her recurrent suicidal thoughts. She also joined a support group which gave her a chance to talk about her suicidal attempts and her experience in general. These treatments helped Sharon manage the trauma by talking about it directly, learned how to handle the symptoms of PTSD, and learned to change her thoughts about the trauma that are not true.

Lengthy Emergency Rooms wait times for psychiatric patients increases the number of potentially suicidal individuals who are at risk for self-harm. These individuals may leave without being seen just as it was the case for Sharon. Also, the bright hospital lights, loud noise, and movement do not provide a comforting surrounding for patients who are already experiencing significant levels of anxiety. A lawsuit could be filed against the hospital if the patient harms him/herself in its emergency room. The American law recognizes that mental illness can negatively affect an individuals mental and physical ability to act responsibly. PTSD is recognized as a mental disorder by law. This means that the law may consider the likes of Sharon mentally ill and as a result, she qualifies to be judged by a different, more tolerant standards from individuals who are considered sane. PTSD can be used in civil and criminal law (Wygant, & Lareau, 2015). For instance, Sharon can sue her former employer for terminating her job contract and not providing reasonable accommodation for her and any other employee experiencing PTSD as required by the Americans with Disabilities Act (ADA).

Ethics are rules or standards which affect and govern how professionals make decisions and conduct their duties. Ethics provide for the morals principles and the framework to follow when dealing with complicated issues. Ethics in Psychiatry are defined by American Psychiatric Association (APA). Its unethical to allow a patient with suicidal symptoms or history to vanish from the emergency room, its the psychiatrist job to keep tabs on Sharon. To ensure Sharons safety, her psychiatric should monitor her access to weapons and should respond to family or friends who call with concerns about her suicidal actions. This would be in agreement with the Principle A: Beneficence and Nonmaleficence highlighted by the American Psychiatric Association (APA) which ensure that Psychologists strive to make sure that those they care for do no harm (American Psychiatric Association, 2016).

To shorten Emergency room wait times for psychiatric patients efforts should focus on management of mental issues in the community rather than in the hospitals. Methods such as Assertive Community Treatment (ACT) and Intensive Case Management (ICM) have been used in the past with great success. These methods are client centered, and they ensure coordinated continuity of care for the mentally ill. They promote community living and reduce the chances of the patient being hospitalized. The government should invest heavily in mental health services. It should create suitable alternatives to emergency rooms that specialize in mental health in all hospitals. The specialized ERs will help to distinguish between medical patients and mental disorder patients, and this can go a long way in reducing the waiting periods for both types of patient. The alternative to emergency rooms could be mobile crisis response team that would provide a mobile and flexible response for mental disorder patients on a twenty-four-hour basis. The hospital sector should be enhanced (Atzema et al. 2012). The hospital should be fully equipped with materials and personnel to deal with the likes of Sharon. The personnel should be board-certified emergency physicians who are skilled in the ethical and efficient use of technical and medical procedures to prevent patients from leaving and congesting the emergency room. These physicians can act as standby psychiatrists in cases where psychiatrist are not available. Increasing the number of psychiatrists in the country would ensure that trained and qualified individuals will treat all patient like Sharon. Currently, most ER staff are not trained in psychiatry, and as a result, they take long to contact qualified psychiatrists hence significantly contributing to boarding.

As argued throughout the paper prolonged wait periods for psychiatric patients in emergency rooms is not only a mental health problem but also a health care sector problem. To ensure that individuals with mental disorders are adequately taken care of medical professionals, hospitals, community, and the government should work together. They ought to expand and redesign the provision of services in the mental and behavior disorder sector. It is crucial to develop community-based, synchronized services to ensure that help is easily and readily available for psychiatric patients. Community-based services such as mobile crisis response will ensure patients can get professional help even while far away from the hospitals and can guarantee an efficient response in case of emergencies such as suicidal attempts or violence. Funding and resources such as beds, human resources, and specialized hospitals will address the challenges faced by the likes of Sharon and other mental health patients. These improvements will provide valuable opportunities to improve the quality of mental health care and reduce the burden of long waiting periods in the emergency rooms for patients.

References

Gupta, A. (2016). Ethical, legal and forensic Issues in geriatric psychiatry. The American Journal of Geriatric Psychiatry, 24(3), S11.

Molewijk, B., & Reiter-Theil, S. (2016). The particular relevance of clinical ethics support in psychiatry: Concepts, research, and experiences. Journal, 11(2) 4344.

Moy, E., Coffey, R. M., Moore, B. J., Barrett, M. L., & Hall, K. K. (2016). Length of stay in EDs: Variation across classifications of clinical cond...