Research: Mental health emergencies triple after cuts to psych services

When mental health services were scaled back in Sacramento there was a significant increase in emergency psychiatric consults and emergency department length of stay

WASHINGTON — Reduction in psychiatric services led to more than triple the number of emergency psychiatric consults and 55 percent increase in length of stay for psychiatric patients in emergency departments.

A new study published in Annals of Emergency Medicine and conducted in Sacramento County, California, examined the before-and-after impact of cuts to mental health services.

"As is often the case, the emergency department catches everyone who falls through the cracks in the health care system," said lead study author Arica Nesper, MD, MAS of the University of California, Davis.  "People with mental illness did not stop needing care simply because the resources dried up. Potentially serious complaints increased after reductions in mental health services, likely representing not only worse care of patients' psychiatric issues but also the medical issues of patients with psychiatric problems."

After Sacramento County in California decreased its inpatient psychiatric beds from 100 to 50 and closed its outpatient unit for psychiatric patients, the average number of daily psychiatry consults in the emergency department increased from 1.3 to 4.4.

The average length of stay for patients requiring psychiatric consults in the emergency department increased by 55 percent, from 14.1 hours to 21.9 hours, 350 patients (out of a total of 1,392 patients undergoing psychiatric evaluation) being held longer than 24 hours. 

The study period was 16 months: eight months before the cuts and eight months after.

"Between 2009 and 2011, $587 million was cut from mental health services in California," Nesper said. "These cuts affect individual patients as well as communities and facilities like emergency departments that step in to care for patients who have nowhere else to turn."

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