The Difficulty in Correctly Assessing Mental Health Disorders in Emergency Departments

By David Weiss, MD  |  Chief Medical Officer, MindCare  |  January 31, 2019

Behavioral Health in the ED

Imagine feeling sharp, persistent pain, shortness of breath, and weak from lack of sleep. You go to the ER but they send you away with no answers, and still in agony. This is not the first time you have been turned away without answers. You feel helpless. Something is wrong but everyone thinks you’re faking it or just seeking attention. This is what it’s like to be one of the millions of Americans who live with undiagnosed mental illness.

Untreated mental illness is a growing concern in the United States. We are told to stay home and take time off if we are sick with a cold or the flu, but patients dealing with severe depression or anxiety do not receive the same understanding. It’s estimated that 1 in 5 U.S. adults have a mental illness, and many are left undiagnosed and untreated. Left untreated, mental illness can lead to dire consequences, including loss of work, trouble with the law, deteriorating physical health, substance abuse, self-harm, and suicide. The National Alliance on Mental Illness estimates that untreated mental illness leads to a loss of over $100 billion dollars in lost productivity annually in the U.S.

Mental Health vs. Physical Health

One reason patients often go undiagnosed is that mental illness can mask itself in physical complaints. These physical symptoms have no identifiable cause and are referred to as medically unexplained physical symptoms (MUPS). The psychiatric classification for patients with MUPS is somatization disorder. These patients are “frequent fliers” in ERs and often present with multiple ongoing complaints. They will undergo costly and potentially dangerous medical workups and even repeated hospitalizations. After all of that, many are sent home without answers.

Patients who suffer from this disorder are not faking their symptoms, even though there is no physical explanation for their presentation. Rather, these physical symptoms are the manifestation of psychological distress and are experienced as real pain.

The growing number of undiagnosed and undertreated mentally ill patients leads many to seek care at emergency rooms (ER). Psychiatric patient visits to the emergency room (ER) are increasing and outpacing non-psychiatric visits. Between 2002 and 2011, psychiatric visits to the ER increased by 55%. Unfortunately, emergency medicine physicians do not receive adequate training on how to recognize or treat somatization disorder.

Multiple negative workups should alert ER physicians to consider psychiatric presentations instead of physical ones. The problem is many ER physicians are hesitant to identify a psychiatric condition when psychiatric consultants are not available. Problematically, few ERs have access to psychiatrists. Only 16.9% of ER physicians report having a psychiatrist on call, and just 11.7% report having one on call for psychiatric emergencies.

This leads to mentally ill patients getting lost in the system, lacking the critical care they need. Further complicating the problem, hospitals often do not have beds available for mental health patients. This situation causes “psychiatric boarding” as patients are forced to wait in limbo, or more often a hallway, until a bed becomes available. Psychiatric patients’ wait for a bed can be up to three times longer than patients waiting for a medical bed. This wait-time can worsen psychological distress, creating or increasing the need for an inpatient stay where one might not have existed at intake.

ERs were created to serve patients who face urgent, life-threatening situations. But today, they are called on to also be a major source of revenue for hospital systems and a safety-net provider for the poor and uninsured. All of this adds up to overworked, ill-equipped staff members, and mentally ill patients being left in the dark.

A Telepsychiatry Solution

With the help of telepsychiatry, there is now hope and help for these patients. Telepsychiatry companies, like MindCare, are well-equipped to fill in these gaps in psychiatric care. By quickly connecting patients with mental health professionals, telepsychiatry has been shown to reduce the length of stay in an emergency department, lower patient costs, and reduce on-call burden for mental health professionals. It also provides a solution to the ever-growing physician shortage, allowing patients to have access to care even in areas where specialty services are not available locally.

The relief that patients feel when they receive a diagnosis of mental illness is frequently underestimated. It is normal for patients to go through a range of emotions, but for many a diagnosis can bring back a sense of control. Having that knowledge provides comfort, even if the road ahead may be long. They are finally able to put a name to a problem. Telepsychiatry can help address the challenges of treating mental health in ERs by connecting patients and mental health professionals – complementing in-house teams to provide the best care possible for patients and reduce stress on hard-working ER teams.

2019-02-04T13:59:08+00:00