Hospitals Specialists Supply of Medical Services

Psych Boarding in the ER

The president of the American College of Emergency Physicians, Michael Gerardi, was recently interviewed about his plans for the organization.  One of his key initiatives will be to stop the practice of housing psychiatric patients in the ER. According to Dr. Gerardi:

It is inhumane that a lot of patients, especially adolescent patients, sometimes live in an emergency department for days. We have stories of patients in the emergency department waiting for a bed, a patient bed, for over a week.

That’s got to stop.

In fact, there are models out there now where you can take a person in a mental health crisis to a separate screening and treatment center, not an emergency department, and you have the same outcomes with safety and more humane treatment. In fact, their length of stay are dramatically shorter in these — it’s called the Alameda model — outpatient centers.

How much of Dr. Gerardi’s objective is focused on what is best for psychiatric patients and how much is motiviated by helping ER docs and ER providers to get out of the (likely less profitable) business of treating mental illness.

Monica Oss of Open Minds makes an important point, that even if the status quo is suboptimal, banning psychiatric ER boarding may not be welfare improving if there are no alternatives available to patients with serious mental illness.

My concern is that psychiatric boarding will be “banned” without formal alternatives developed for these consumers. In an era of parity and expanded health care coverage, there should be funding for these alternatives. But monitoring whether the “ban” increases rates of homelessness and incarceration is critical to assuring we don’t repeat past policy mistakes.

An interesting topic that the Healthcare Economist will be monitoring.


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