A Great Depression: Why Mentally Ill Patients Aren't Being Treated

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With the ongoing economic crisis, doctors are seeing a spike in psychiatric emergencies at the same time state budgets are being slashed.

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On a recent shift at a Chicago emergency department, Dr. William Sullivan treated a newly homeless patient who was threatening to kill himself. "He had been homeless for about two weeks. He hadn't showered or eaten a lot. He asked if we had a meal tray," said Sullivan, a physician at the University of Illinois Medical Center at Chicago and a past president of the Illinois College of Emergency Physicians. Sullivan said the man kept repeating that he wanted to kill himself. "It seemed almost as if he was interested in being admitted."

Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies -- attempted suicide, severe depression, psychosis -- as states slash mental health services and the country's worst economic crisis since the Great Depression takes its toll. This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.

The woman asked Sullivan to switch her prescriptions to drugs that could be found on the $4 list at Walmart.

"These are people without a previous psychiatric history who are coming in and telling us they've lost their jobs, they've lost sometimes their homes, they can't provide for their families, and they are becoming severely depressed," said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.

Visits to the hospital's psychiatric emergency department have climbed 20 percent in the past three years. "We've seen actually more very serious suicide attempts in that population than we had in the past as well," she said. Compounding the problem are patients with chronic mental illness who have been hurt by a squeeze on mental health services and find themselves with nowhere to go. On top of that, doctors are seeing some cases where the patient's most critical need is a warm bed.

"The more I see these patients, the more I realize that if it's sleeting and raining outside, the emergency room is the only place they have," said Dr. R. Corey Waller, director of the Spectrum Health Medical Group Center for Integrative Medicine in Grand Rapids, Michigan.

Government agencies such as the National Institutes of Mental Health, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration could not provide fresh data on use of psychiatric services in recent years. But doctors from more than a dozen hospitals nationwide, mental health advocacy groups, and state-funded agencies told Reuters they are all seeing a marked increase in psychiatric emergencies.

A WORSENING PROBLEM

The National Association of State Mental Health Program Directors (NASMHPD), an organization of state mental health directors, estimates that in the last three years states have cut $3.4 billion in mental health services, while an additional 400,000 people sought help at public mental health facilities. In that same time frame, demand for community-based services climbed 56 percent, and demand for emergency room, state hospital, and emergency psychiatric care climbed 18 percent, the organization said.

"This wasn't one round of cuts," says Ted Lutterman, director of research analysis at NASMHPD Research Institute. "It was three or four for many states, and multiple cuts during the year."

If the economy doesn't improve, next year could be worse because many community mental health agencies are cutting programs and using up reserve funds, says Linda Rosenberg, president of the National Council for Community Behavioral Healthcare. "It's been horrible," she said. "Those that need it the most -- the unemployed, those with tremendous family stress -- have no insurance."

In the emergency room, this increased demand has meant doctors and social workers are spending hours and sometimes days trying to arrange care for psychiatric patients languishing in the emergency department, taking up beds that could be used for traditional types of trauma.

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Julie Steenhuysen is a reporter for Reuters.

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