Psychiatric patients still flood ERs

Four years after Tropical Storm Irene caused structural damage to the state’s psychiatric hospital, Vermont’s system of psychiatric care offers more beds for patients in crisis, yet hospitals around the state find themselves trying to care for individuals left waiting in emergency departments for a psychiatric bed.

Gifford Medical Center in Randolph has five emergency room beds and is not one of the state’s designated mental health facilities. “As you can imagine, it does not take much for it to become very crowded,” said Barbara Quealy, chief operating officer. “Our biggest challenge here remains the ability to quickly move patients to the inpatient facilities when their mental health needs are identified.”

Jessica Ryan, director of nursing at Gifford, said patients dealing with a mental health crisis waiting in Gifford’s emergency room are not receiving therapies they need. “They are not getting counseling; they are not even given the opportunity to take medications,” she said. “If they come in on medications, we of course try to continue them, but our physicians are not psychiatrists so they can’t prescribe new medications, if the patient is even willing to take the new medication. We can’t even offer that option.”

Over a four-month period at the end of 2015, the hospital had more than 687 patients registered with a psychiatric complaint – the majority related to depression and drug-related issues, Quealy said. During that same time period, there were four heroin-related overdose deaths in Gifford’s emergency department.

Quealy and Jill Mazza Olson, vice president for policy and legislative affairs for the Vermont Association of Hospitals and Health Systems, said it’s an issue hospitals across the state are dealing with, even with the opening of the Vermont Psychiatric Care Hospital in July 2014.

“All of our hospitals are experiencing this change from how things were five years ago, where it’s not uncommon to have someone who is in very significant mental health crisis wait for a long time in the emergency department,” Olson said. “That is not to say we haven’t made some progress.”

A Vermont Department of Mental Health report on Act 79, which was passed by the Vermont Legislature in 2012 to rebuild the state’s system of mental health care after Tropical Storm Irene, says there has been progress:

• With the additional services implemented in fiscal year 2014, and with the opening of the Vermont Psychiatric Care Hospital in fiscal year 2015, the numbers of patients waiting for admission and the lengths of time they spend in Emergency Departments or the Department of Corrections has decreased;

• The system capacity for psychiatric beds has increased by almost 50 beds since August 2011. State capacity for adult inpatient beds is 188, which includes 45 Level 1 beds, which slightly exceeds pre-Irene numbers;

• Crisis and intensive residential beds have increased from 49 (Pre-Irene) to 87;

• There are 45 Level 1 beds available for patients throughout the state at the Vermont Psychiatric Care Hospital in Berlin, Brattleboro Retreat, and the Rutland Regional Medical Center, and the highest average daily census was 48 (May-June 2013), just three over available beds. Numbers indicate the state has not exceeded capacity since the opening of Vermont Psychiatric Care Hospital in July 2014.

Yet, the report states that “emergency departments across the state have had to hold individuals needing inpatient psychiatric care while waiting for an open bed.”

“This is disruptive to the emergency care setting and not a standard that the department regards as adequate for individuals requiring inpatient care,” said the report.

According to the report, trends indicate an increase in the length of hospital stays from an average of 33 days to 42 days. “The data suggests that patients with higher acuity are being treated on an inpatient basis, reflected in the longer lengths of stay.”

Mental health commissioner Frank Reed, LICSW, said all components of Act 79 have been implemented, except for seven intensive residential recovery beds that were authorized in the bill but not funded.

“The State of Vermont and the Department of Mental Health have made significant inroads to replacing inpatient bed capacity lost through a natural disaster four years ago, as well as developing a more robust community-based system of care to effectively serve people in their communities to the greatest extent possible,” he said. “The system of care that is emerging is still young and fragile and needs our on-going attention and support to ensure that it fully meets the needs of individuals in Vermont over the long term.”

Olson says the association, which represents Vermont’s nonprofit hospitals including Brattleboro Retreat, is working with the state to improve Vermont’s system of care.

“Everyone wants to provide the best care of the people who come into the hospital,” she said.