“The extent to which ERs are now flooded with patients with mental illness is unprecedented,” said Dr. David R. Rubinow, chairman of the Department of Psychiatry at the School of Medicine at University of North Carolina, Chapel Hill.
And this overflow is “having a really destructive effect on health care delivery in general,” he added. “There are ERs now that are repeatedly on diversion — which means they can’t see any more patients — because there are so many patients with mental illness or behavioral problems that are populating the ER.
A 2017 government report found that the overall number of emergency department visits increased nearly 15% from 2006 to 2014, yet ER visits by patients with mental or substance use disorders increased about 44% in the same period
This supports Rubinow’s belief that ERs are a major provider of mental health care for a “very, very sizable percentage of patients” these days.
Dr. Catherine A. Marco, from her vantage point as an emergency physician professor at Wright State University in Dayton, Ohio, said, “we commonly see depression, anxiety, substance-related conditions and suicidal behavior.”
Firsthand experience suggests to Dr. Mark Pearlmutter, an emergency physician in Boston, that the most common mental health problems in emergency rooms are dual diagnoses, such as “substance abuse and depression, for example.” He’s also seen cases combining acute psychosis, bipolar disorder, suicidality, aggression and (mal) adjustment disorders.
“We’re the safety net,” he said.