The need for a psychiatric emergency intervention program in a Detroit medical center became clear in 2013 after it was halted and patient outcomes worsened. Results improved drastically when it was reinstated four months later.
The program reduced needless psych admissions and readmissions, and ran for nine years before new medical leadership terminated it. Subsequently, hospitalization rates surged 4.5 percent and lengths of stay climbed 59.4 percent. That added up to an extra $623,000 in monthly costs, according to a study, “Intervention to Reduce Inpatient Psychiatric Admission in a Metropolitan City,” published online by the Community Mental Health Journal.
“When the program stopped, outcomes worsened and hospitalizations increased with enormous increase in costs,” says the chair of Wayne State University’s psychiatry and behavioral neurosciences department, David Rosenberg, M.D., who helped to oversee the study. When the program was restored, the number of psych admissions fell by 94 percent.
Researchers at the university’s Physician Group Crisis Center (inside Detroit Medical Center’s Detroit Receiving Hospital) found that evaluating patients immediately upon their arrival with the aid of an entire mental health team enabled them to assess and begin to treat the underlying causes of patients’ ailments right away, lessening the need for inpatient care.
“As an acute care-focused psychiatrist, I observed that many patients did not need to be on the psychiatric units,” says Alireza Amirsadri, M.D., chief medical officer, who led the study. “Many of these individuals were under the influence of drugs or alcohol. [Patients] need help with their problems, but not in an inpatient psychiatric unit.”
The timing may be right for hospitals to adopt a program like this. Washington state recently ruled that holding mentally ill patients in emergency departments until mental health beds become available is unconstitutional.
Emergency medical physician Mark Pearlmutter says that while this type of centralized system is preferable to the model many hospitals use, its financial viability hinges on communitywide support. The mental health patient population usually is the most difficult to treat, he says. “So, you as an individual hospital really are at a loss to handle this population," he explains. "You really do need a systemwide response. You need payers to coordinate it and you need the actual infrastructure to develop it."