Judge Steven Leifman said that he is more likely to see individuals suffering from a mental illness or in a mental health crisis than a psychiatrist.
Additionally, the Fred Friendly seminar, which presents a social dilemma to noteworthy panelists, emphasized that emergency departments (ED) get so overwhelmed that a patient seeking help for mental health issues, who gets turned away to outpatient care, rarely makes these appointments. They might end up homeless and in trouble with the law.
I am taking a neuro-ethics course this semester, and a few weeks ago, we discussed schizophrenia. We watched the Fred Friendly Seminar Minds on the Edge: Facing Mental Illness, which features experts like Judge Leifman. As I have previously written about homelessness, I wanted to further investigate the connection between mental health, homelessness, and the legal system.
For many individuals the ED is their last resort to get the assistance they need; however, emergency rooms are not properly equipped to aid those suffering from a mental health crisis. The results of a 2015 study showed that one out of every eight ED cases concerns “mental health or substance abuse issues”. Yet, EDs are not equipped to provide this kind of immediate care. They generally refer such patients to an outpatient clinic. However, the appointments are often days out, which does not provide the urgent care that many of these individuals need. So, what ends up happening to the patients experiencing a mental health crisis who do not receive immediate care?
The responsibility shifts from the medical care system to the legal or welfare system. Mental illness is the third-highest contributor to homelessness recorded in many cities in the United States. According to the largest survey of homelessness done in the United States, on any night 564,708 individuals were homeless. Of this number, 25 percent had a severe mental illness and 45 percent were experiencing any type of mental illness.
According to the Associated Press, “At any given time, there are many more people with untreated severe psychiatric illnesses living on America’s streets than are receiving care in hospitals.”
Mental illness is a high contributor to homelessness, and the traumatic experiences caused by unstable housing and living on the streets lead to a higher risk of mental illness. Around one-fifth of men and one-third of women experiencing chronic homelessness suffer from substance abuse or PTSD. The lack of stable housing can also contribute to the development of a mental illness. There must be intervention in this cyclical process.
What needs to change?
Caregivers in the emergency room need to be trained to identify when an individual requires immediate help for a mental health crisis. The Treatment Improvement Protocol (TIP) urges that ED medical staff need to be aware of the comorbidities and trauma experienced by people experiencing homelessness. There are a few gaps that separate patients from the care they need. A primary issue is that there is not a level of standardization among medical institutions regarding how to effectively treat a mental illness. Also, providers may not have the right training to recognize the signs and care for such individuals. While the emergency department is equipped with a variety of talented professionals, 61 percent of EDs do not possess the psychiatric staff capable of caring for those suffering from a mental health crisis.
Unfortunately, emergency departments were already struggling to find beds for these patients before the pandemic. Fewer rooms in the ED means that patients in a mental health crisis have to wait longer for the care they urgently need. A study of 6,000 emergency rooms across the United States found that roughly “70 percent of ERs reported boarding psychiatric patients”. Boarding refers to the lengthened periods of time where the ER holds a psychiatric patient before a bed is open.
Are there current efforts to resolve these issues?
The AAMC reports that many teaching hospitals are developing programs to start to accommodate the influx of mental health patients. The development of such programs was imperative since ED visits related to suicidal thoughts increased by 415 percent between 2005 and 2014. There is an even greater need for these programs because of the current mental health crisis caused by the pandemic. The level of suicidal ideation has doubled since 2018. There are numerous call lines and a variety of services available for individuals in crisis, but could more be done?
Yes, more could be done, and more should be done.
Emergency departments need in-house psychiatric staff who are trained to recognize the signs and can treat individuals struggling with a brain disorder. There must be communication with the hospital and out-patient or psychiatric facilities who may have immediate beds available. This would allow for quicker treatment. It would also be beneficial for hospitals to have specific wings available for psychiatric patients. Additionally, many individuals with a mental illness require access to stable housing to be treated properly. Since many individuals experiencing homelessness suffer from a mental illness, new programs need to be catered to this specific population. The creation of facilities open to people struggling with housing instability would be a step in the right direction. There also needs to be more mental health services accessible to individuals experiencing homelessness beyond those provided by shelters.
If we can successfully provide immediate assistance to those in a mental health crisis, not only could we help many individuals get the treatment they need, but the number of individuals experiencing homelessness could be reduced. Mental illness, especially of those who are homeless, must be treated as a health issue rather than a criminal one. Thus, increasing the number of individuals who see a psychiatrist rather than appearing before Judge Leifman in court.
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