Thank you for your recent article on Porter Hospital’s difficulties with “boarding” patients with psychiatric emergencies in the Emergency Department. It is time that some light was shed on this situation.
The current state of mental health care in Vermont is deplorable. Our counseling service is an invaluable resource and do the best that they can with the available funding and staffing, but they are unable to care for the sickest patients in an E.D. setting with no inpatient psychiatric beds, just as our local cardiologists are unable to perform cardiac catheterization on our sickest heart patients.
It is a travesty that patients have to spend weeks on end in our department. These individuals are often anxious, upset and frightened, and the stimulating environment of the emergency department with beeping monitors, overhead announcements, bright lights, ambulances coming and going outside their door, crying infants, etc., is probably the least appropriate setting for these patients to be lodged.
Some patients may be volatile, unpredictable and violent as part of their illness, posing a threat to staff as well as other patients, some of whom are quite frail. As we are unable to medicate patients against their will except in the most extreme situations, they are basically sitting in our department getting minimal treatment.
Patients with psychiatric emergencies have real illness. No other subset of our sickest patients languish in our department because there is “no room” for the patient in a diabetic coma or having a stroke or heart attack. Mental health patients are equally ill with symptoms beyond their control. Until the state recognizes this and expands the availability of inpatient beds for patients in acute crisis to the level that was present before Hurricane Irene, I am afraid that this situation will not improve.
Jessica Racusin, MD
Middlebury