President’s Message
Psychiatric Emergencies (Updated February 17, 2010)
Every day, emergency rooms throughout Massachusetts address Psychiatric Emergencies. The American Psychiatric Association defines such an emergency as:
An acute disturbance of thought, mood, behavior or social relationship that requires an immediate intervention as defined by the patient, family or the community.
According to a study by the Psychiatric Emergency Research Collaborative [1]about ten percent of all hospital emergency room visits involve a psychiatric emergency and the rate is increasing. Alcohol, drug-related emergencies, delirium, domestic violence, depression and anxiety disorders, acute psychosis, and violent behavior are associated with these visits. Fifty five percent of the patients threaten self harm. Twenty percent threaten harm to others. The police are frequently involved. Forty five percent will be admitted to an inpatient unit or observation unit – some involuntarily. Six percent will be physically restrained. Family members, friends, spouses, and partners are frequently involved.
Most hospital emergency departments are not adequately prepared to handle a psychiatric emergency. A person in a psychiatric crisis being treated in an hospital emergency department may wait hours before seeing a clinician trained to screen and treat the situation. Patients in an acute crisis may experience hours or even days of delay before they can be assessed, stabilized, and acute care initialized. Continuity of care is an issue. Patients find themselves shifted from one treatment facility to another, and treated by different clinicians at every stage of their movement.
The police and the first responders may have little training regarding mental illness. A person experiencing a psychiatric emergency may not have committed a crime, has not given up their civil rights, remains a vulnerable human being, and deserves compassionate, respectful, legal and ethical treatment. In many psychiatric emergencies a person in crisis may not ask for help, may resist assistance, and may deny they have any problem.
In 1975, the United States Supreme Court ruled that involuntary hospitalization and/or treatment violates an individual’s civil rights. The results of this decision has forced states such as Massachusetts to change their statutes regarding involuntary commitment and treatment. In Massachusetts an individual must exhibit behavior that is a danger to himself or others in order to be held for observation, usually 72 hours. A court order can extend this period of involuntary treatment or hospitalization.
During such a psychiatric crisis, police officers, emergency responders, medical doctors, family members, partners, and friends, all well meaning, wield tremendous power over a person in crisis. At times this power is misused. A person with mental illness, who finds themselves at the center of this emergency, is more likely to be ripped from their support environment, and processed by an overworked group of people not prepared to adequately handle psychiatric emergencies and end up in a strange treatment environment being treated and living with strangers. Frequently, the civil rights of a person in crisis are violated.
Who should you call for help during a psychiatric emergency? Do you call 911, the police, your doctor, Samaritans, or Psychiatric Emergency Services(PES)? Advocates’ Psychiatric Emergency Services (PES), is the MetroWest Area provider funded by the Massachusetts Behavioral Health Partnership and the Department of Mental Health. PES is infrequently called. Most people who can use PES have never heard about this service.
PES is designed to deal with these emergencies. Early and effective intervention in a crisis can lead to recovery and growth. The goal of the PES mobile team, which is available 24 hours per day, 365 days per year, is to provide customer friendly, community-based, proactive intervention services through collaboration with the individual, family members, providers and other community agencies. PES meets individuals experiencing a behavioral health crisis in the least restrictive setting possible, making every effort to honor the person’s dignity, respect the person’s rights, afford the person as many real choices as we can within the scope of the person’s risk factors, and take positive, affirmative actions to foster the person’s wellbeing.
The PES team has found evaluations in homes and other natural settings incalculably more valuable for the consumer’s comfort and the clinician’s depth of clinical understanding and knowledge. Mobile evaluations in homes or community settings provide a non-threatening setting for people to be assessed, stabilized and diverted from unnecessary emergency room visits, police involvement and inpatient admissions.
In the Framingham area you can reach PES at 800-640-5432.
What is your opinion about the above article?
Tina
[1] General Hospital Psychiatry, Psychiatric Emergency Research Collaboration, Volume 31, Issue 6, November 2009, pages 515 – 522.
