At any given time, the emergency department at Johns Hopkins University Howard County Medical Center treats an average of 11 patients with a mental health or substance use crisis per unit. Only 6 of them are equipped. Dr. Shafiq Ahmed, the hospital's president, said behavioral patients in the emergency room often wait 24 hours before being transferred to a facility with open beds.
But Howard County hospitals plan to quadruple the number of behavioral health beds next fall. Construction is about to begin on a 7,000-square-foot “transition space” for more modern treatment while the 24 patients await placement in an inpatient facility or until they are stable enough to be safely discharged.
It may also reduce ER wait times for everyone else.
“This is a really great move for people with behavioral issues who come to the emergency room.” Ahmed said. “But it also helps when using the emergency room in general, because it opens up space for people who don’t have mental illness.”
Patients who require psychiatric hospitalization to recover from a mental health crisis are typically suicidal, homicidal, or experiencing symptoms of a serious mental illness that is dangerous, and therefore inpatient beds are not available. You will have to stay in the emergency room until it is found.
Delay in discharge of behaviorally abnormal patients That's one reason Maryland has some of the longest emergency room wait times in the nation. A 2019 study by the Maryland Hospital Association found that 42% of behavioral disorder patients experienced delays in discharge or transfer, and these wait times accounted for nearly half of the time spent in the emergency department, resulting in patient It was found that the average total time per person was 20 hours.
The same study found that children and teens were twice as likely to lag behind as adults.
Between 2016 and 2020, the number of emergency department visits for behavioral health increased by 12%, while the number of emergency department visits for all other reasons decreased by 11% over the same period. . According to the hospital association.
Working long hours in an already crowded emergency department that is not exclusively for psychiatric treatment, Mental health symptoms worsen.
Howard County Medical Center has 20 inpatient psychiatric beds available for adults and Shepard Pratt. The psychiatric hospital in Elkridge has an additional 85 beds for adults and adolescents. Patients who otherwise visit the ER or behavioral health unit and need more intensive care will be transferred to other psychiatric facilities in the state, depending on available space and individual needs, Ahmed said. said.
Howard County Medical Center's pediatric emergency department has a behavioral health unit that can accommodate four children, but the hospital does not have an inpatient psychiatric unit for children, and there is none in Howard County, Ahmed said. said.
Because ERs are so accessible to patients, behavioral health care is disproportionately burdened. Most outpatient psychiatrists and psychotherapists do not accept public insurance, and many only accept cash.
Psychiatrists definitely Least likely of all specialists Although we accept all types of insurance, the high demand for mental health care allows us to operate a busy practice without insurance.
When patients with mental health problems don't have access to outpatient treatment, “their condition deteriorates and they really need urgent mental health support,” Ahmed said. In many cases, the ER is the only option.
And once patients are discharged, whether from the ER or inpatient care, they can be connected to consistent outpatient care that helps prevent mental health crises and repeat visits to the emergency room. “It's one of the challenges that we continue to grapple with. Not just this hospital, but all of our hospitals,” Ahmed said.
