SAN DIEGO — The pressure to better tend to the needs of those afflicted with mental health issues is mounting as health care evolves, speakers told attendees of the Health Forum-American Hospital Association Leadership Summit.
Former U.S. Rep. Patrick Kennedy, a keynote speaker who has experienced his own battles with bipolar disorder and substance abuse, spent his congressional career fighting for better mental illness treatment, championing the Mental Health Parity and Addictions Equity Act of 2008. Still, years later, the act still isn’t fully implemented and enforced, he noted.
Kennedy said during his remarks at the Summit that it’s long past due that the silos between mental and physical health care be broken down. Often, hospitals and other providers traditionally haven't acted on mental health issues until they snowball and result in a visit the ED. He contrasted health care’s current approach to mental health with how it addresses cancer. No oncologist would wait until an early onset, perfectly treatable tumor reaches Stage 4.
“That’s what we do to people with mental illness and addiction. We wait until their illness is critical and then we may or may not treat it because by that point the illness is so pathologized it’s difficult to treat,” Kennedy said. “Well guess what? It’s also difficult to treat Stage 4 cancer. So why are we surprised?”
Kennedy gave one example of how health care’s silos nearly derailed his well being, relating a story of getting treated for an injury, with a doctor attempting to give him opioids for pain, despite his history of addiction and statement that he was allergic to the drugs. He probably would have taken the pills if his wife wasn’t near by.
“I am an absolute believer that we cost people lives by not integrating addiction medicine into overall medicine,” he said.
In another session at the Summit, experts with the American Association for Emergency Psychiatry illustrated some of the challenging numbers that clinicians in crowded EDs face when mental health problems show up there. Studies have found that the average psychiatric patient must wait 11.5 hours during each ED visit, and 15 hours for an inpatient bed. Boarding can cost a hospital dearly, at an average price of $2,264 per person, with the patient’s symptoms often exacerbating during that wait.
A sounder approach, the association believes, would be to make better use of psychiatric EDs. And yet, there are only about 140 of such facilities in the country, compared to nearly 4,000 traditional emergency rooms. About 10 percent of ED volume is from patients with a psychiatric issue, they’ve found. Of those other 90 percent that make up the regular acute care volume, about 45 percent screen with a mental illness.
“Where did we ever get that idea that the emergency departments are the great arbitrators of disputes?” said Leslie Zun, M.D., president of the AAEP and chairman of emergency medicine in the Sinai Health System in Chicago. “I think we really set ourselves up for failure and significant cost in the health care system by really not providing the resources at the site.”
Zun highlighted several innovative approaches that providers are taking to this mental health crisis, be it psychiatric urgent care clinics offering group therapy and psychiatric evaluation on a walk-in basis, crisis-oriented treatment in patient’s place of residence, or roving mobile crisis units. Hospitals that are moving into value-based models of care need to be thinking about these types of approaches to succeed, Zun believes.
“All those that are involved in ACOs, you better be addressing their psychiatric problems because a lot of your patients have them, and if you don’t address it, their medical problems are going to suffer, as well,” Zun said.