1 / 20

Emergency Department Insight: “Behavioral and Mental Health Perspectives”

Emergency Department Insight: “Behavioral and Mental Health Perspectives”. Mark E. Gebhart, M.D. Department of Emergency Medicine Boonshoft School of Medicine Wright State University Dayton, Ohio. Learning Objectives. Define the role of emergency departments in modern health care systems

kayo
Download Presentation

Emergency Department Insight: “Behavioral and Mental Health Perspectives”

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Emergency Department Insight:“Behavioral and Mental Health Perspectives” Mark E. Gebhart, M.D. Department of Emergency Medicine Boonshoft School of Medicine Wright State University Dayton, Ohio

  2. Learning Objectives • Define the role of emergency departments in modern health care systems • Discuss the impact of homelessness, mental illness, and substance abuse on the emergency care system • Describe where we are currently and identify possible solutions for the future

  3. Welcome to our world! “It’s Friday night, nearly midnight, 147 patients and counting. Security to bed 53 STAT!”

  4. Emergency Departments • Universal health care – access • 100 million + visits per year • Critical interface – hospital and community • 24/7/365 • All patients • Our nations “safety net”

  5. What are they designed for? • 24 hour acute care • All ages • Medical • Trauma • Men, women, children • High tech emergency medical care

  6. What aren’t they designed for.. • Boarding patients • Holding psychiatric patients • Drug detoxification • Sheltering • Primary care clinic

  7. Social Needs, Mental Illness and the Emergency Department • Who are the users? • Homeless – higher incidence of mental illness • Substance abusers • Incarcerated population • All races • All genders • Even children

  8. Individual Populations • Homeless • San Francisco – 40% use ED • Three times higher than the national average • Critical social needs • Go unaddressed in the ED • Not designed for this • This leads to a cycle of continual use

  9. Homelessness: A Critical Emergency Department Issue • 3.5 million in the US • 37% of shelter requests go unmet • “Hidden homeless” • Uncounted • Stay in automobiles • Campgrounds • Public parks • Other “unofficial residences” • Tents, boxes, caves, boxcars

  10. Are ED’s the place? • Not equipped to shelter • Poor nutritional support • Inadequate counseling • Understaffed to attend to+ • Attend to social aspects • Drastically decreased social services • More than 50% reduction in 2 years

  11. Substance Abuse and the ED • 20% of patients = Alcohol • 700,000 cocaine users in US • Other drugs • Prescription drug abuse • Significant • Drug seeking behavior • Street drugs

  12. The Cost of Drugs

  13. ED’s Aren’t…. • Designed to: • Treat substance abuse • Counsel substance abusers • Deal with long term issues • Priority is often low • Leads to no or minimal intervention • Leaving without treatment • Underlying medical disorders go untreated

  14. Incarcerated Population • Limited access to medical care • Uses of ED’s: • Refuge • Secondary motive • The 2nd opinion • Mental health issues • Depression • Suicidal ideation • Personality disorders

  15. Incarcerated Population • ED’s not designed for: • Social intervention • Refuge • Mental health care beyond stabilization • ED’s have no mechanism for: • Continuity of care with jails/prisons • Have little extra staff for security

  16. Mental Illness and the ED • Public health emergency • Depression cost = $44 billion/yr • Suicide 11/100,000 • Affect of mental illness on ED: • Negative affect on access to care • Longer wait times • Patient frustration • Limited availability of hospital staff • Decreased ED beds

  17. Mental Illness in the US

  18. Why the Increase? • Federal and state budget cuts • Decreased beds • No where else to turn • The result • Psychiatric patients board 2X as long • Illness worsens • What can help? • Community based resources • Ongoing efforts

  19. "Emergency department overcrowding is a growing and severe problem in the United States," said Dr. J. Brian Hancock, President of ACEP. "As dedicated as emergency physicians and nurses are to caring for patients, we are reaching a breaking point where we may not have the resources or the surge capacity to respond effectively. This affects everyone’s access to lifesaving medical care."

  20. What do we do? • ED’s offer: • Compassionate, high quality medical care • Examine our system • Resources external to emergency departments • Community strengths • Augment social services • Care outside the ED

More Related