Patients with mental illness are being detained in emergency rooms, often for weeks at a time. Now some states are rethinking the entire psychiatric care system.A couple of years ago, in Pierce County, Wash., 10 mental patients spent extended periods in hospital emergency rooms after suffering psychotic episodes. This was against the rules: Washington state law requires that such patients see a psychiatrist and then move to a mental health facility or psychiatric unit within a larger hospital. But in each case, the hospital staff simply couldn’t find a place that had any room. So the patients stayed in the ER — some for as long as two weeks.
This practice is called psychiatric boarding, and it happens all over the country. It’s often the only option for emergency room staff; they can’t turn away mentally ill patients, even though they’re not trained to deal with them. Essentially, all they can do is stabilize the patients and keep them in bed, often in seclusion or strapped down for days or weeks at a time.
Psychiatric boarding is an ugly reality that patients and physicians reluctantly accept. But that wasn’t the case with the 10 patients in Pierce County. Their families sued the state.