Source: NJ Spotlight
Individuals facing a mental health crisis are more likely to seek help through the hospital emergency room than in the past and often languish there for hours or days longer than patients with a physical malady, new studies show. And the problem is growing worse. The findings are based in part on a detailed report by the New Jersey Hospital Association.
Emergency room visits are rising — and nearly half of the increase between 2014 and 2015 involved patients with mental health or substance use disorder diagnoses. While the total number of emergency room visits in the Garden State increased less than 4 percent in that year, ER use by patients with serious behavioral health issues jumped more than 10 percent.
“We know that treating people in a mental health crisis in the emergency department can place stress on the patient; it’s simply not the right setting to handle their complex needs,” said Betsy Ryan, president and CEO of the hospital association. “At the same time, it places increased strain within the emergency department, adding to overcrowding, long waits and increased healthcare costs.”
The healthcare system for those with serious mental illnesses has evolved over the past four decades from one focused on large, residential facilities — often criticized for locking individuals away like inmates — into a complex network of community based non-profit organizations that provide outpatient programs and medical care; smaller, residential group homes; and a handful of state-run institutions.
While many have praised the goal of better integrating individuals with family members and the community, experts agree there has never been enough funding available to create the comprehensive system required to support those in need.
The dwindling availability of inpatient beds, together with a lack of access to appropriate outpatient services, combine to leave patients with few options other than the ER, doctors said. Investing in a system of integrated and preventative care will improve the health of those suffering from mental illness and save money over time.
In the Garden State, nearly 217,000 more patients used the emergency room between 2011 and 2015 — more than half in the last year alone — based on the NJHA’s analysis of hospital billing codes. Nearly two-thirds of these individuals showed up as a result of a behavioral health crisis, or were diagnosed with a mental health or substance use disorder condition while in the ER. Overall, behavioral health diagnoses made 18 percent of the total emergency visits in 2015, the association found, up from 15 percent four years earlier.
The good news, said Ryan said, is that a growing number of the ER’s behavioral health visitors have health insurance; nearly 30 percent had Medicaid coverage in 2015, almost twice the rate in 2011. New Jersey added almost 500,000 residents to the Medicaid rolls since 2014, when the program was expanded under the federal Affordable Care Act.
“It’s great that these New Jerseyans are covered by insurance, but we also need to make sure they have access to appropriate behavioral health services, in the right setting — and that setting should not be the emergency department,” Ryan says.