Mental Health Crisis Strains Vt. Hospitals
Psych Patients Can Spend Days in ER
Motorists traveling along Route 12 past Gifford Medical Center last week were temporarily halted when a patient ran from the hospital’s emergency room and into the road. The patient, who was experiencing an acute mental health crisis, was one of many who now arrive at the ER in need of emergency psychiatric treatment.
Like many throughout the Green Mountain State, Gifford’s emergency room is ill-equipped to handle mental health crises and must transfer those patients experiencing a crisis to facilities designed specifically for acute and/or longterm care.
Ideally, this transfer would happen as soon as possible, in order to provide effective care as quickly as possible while also easing the burden on local ER staff. However, such a rapid transfer to a proper facility in a matter of hours, or even days, is frequently not an option for many patients in Vermont.
The patient at Gifford who briefly halted Randolph traffic before being returned safely to the hospital ended up staying nearly a week afterward as hospital staff and mental health workers struggled to determine where to send the patient. For many in Vermont’s mental health community, including law enforcement and hospital staff, the practice of holding mental health patients in hospital emergency rooms for days represents a systemic failure to address the needs of patients in crisis.
“If a patient is stuck in our emergency room for even 24 hours looking for a mental health bed, that is a failure of the entire system,” said Gifford Chief Operating Officer Barbara Quealy on Tuesday. “It is the least therapeutic, the least healing environment for any patient in mental health crisis,” she said as she ticked off a variety of factors within a typically busy ER that can lead to sensory overload in a crisis patient, including loud alarms, foot traffic, and incessantly bright lighting.
“It’s probably one of the most uncomfortable environments for a mentally ill patient to be,” said Dr. Lou DiNicola, who serves as pediatrician and primary care medical director at Gifford. “It’d be like telling a person with chest-pain, ‘We can’t get you in right now but here’s a treadmill.’ That’s my comparison in my head.”
Shortage of Beds
According to many healthcare professionals, Vermont now suffers from a crippling shortage in mental health care capacity. Exacerbated by the closure of the Vermont State Hospital in Waterbury, the lack of capacity is worsened by inadequate funding and a societal stigma against mental illness.
“The irony is, the more in-crisis they are, the harder they are to find a place for,” said emergency room physician and Gifford’s Medical Director Scott Rodi.
“It’s getting worse. It’s getting worse now at this hospital,” he said. “Nationally, the numbers are increasing everywhere and we are seeing that also. Five years ago [this happened] rarely. Now… it can be weekly. We can have two at a time, tops. For an ER with six beds that’s debilitating,” said Rodi.
Like many community hospitals, Gifford is working to expand its ability to handle, treat, and comfort patients experiencing mental health crises. In addition to improvising more comforting solutions for mental health patients and working with organizations such as the Clara Martin Center to coordinate resources, the hospital has also expanded its staff in an attempt to cope with the influx of crisis patients over recent years.
“We went from essentially zero behavioral health [staff] to now, I think, six people,” said DiNicola. “In the forty-plus years that I’ve been here, this is the biggest increase that we’ve had as far as getting providers here,” he said.
But despite their newly hired staff and increased cooperation with local agencies, including law enforcement, mental health crises remain extraordinarily disruptive to emergency room operations, often forcing staff to work many hours longer than initially scheduled, while raising stress levels at ERs already near capacity.
“That is where we need the state’s help, providing the patient capacity, particularly for these patients [whose needs] are acute,” said Dr. Rodi.
Shortage of Funds
Adequate funding for mental health care infrastructure and human resources has increasingly become the topic of discussion for emergency care providers, mental health workers, and advocacy organizations in recent months. Writing via email, Nick Martin, the Program Director of the Vermont chapter of the National Alliance on Mental Illness, cited the tremendous financial cost to the taxpayer as well as the emotional cost to patients held for extended periods of time in an emergency room setting.
“We’ve advocated for changes from our legislators in Montpelier for improved access and increased resources to help address this issue,” he said via email.
“The human impact of underfunded mental health services cannot be understated. Untreated mental health conditions cost our state in emergency rooms, corrections, homeless shelters, law enforcement, schools, and other public services. People need prompt, immediate care and should not be waiting in emergency rooms,” he said.
At Gifford, Dr. DiNicola noted that the problem had worsened significantly following the damage wrought to the State Hospital by Tropical Storm Irene.
“We’ve had trouble with it over time. We then had the emergency of eliminating 50 beds [in Waterbury] and replacing them with 25 beds [in Berlin]… I personally believe that was a really poor decision at a time when we really should’ve increased the bed capacity,” he said.
Orange County Sheriff Bill Bohnyak reached the same conclusion as Gifford leadership
“The current mental health system is broken,” said Bohnyak, who was forced to personally travel to Gifford hospital due to similar mental health crises unfolding simultaneously around the state.
“The legislators need to do a better job of fully funding our mental health facilities,” he said in a telephone interview on Tuesday, as he described the strained schedules and resources resulting from the long hours of unexpected overtime required to monitor patients being held in ERs across the state.
“It’s a dangerous situation,” he said. “In the big scheme of things, our legislators need to concentrate [on] mental health care and the opioid crisis and stop worrying about marijuana,” he said emphatically. “And you can quote me on that.”