“Do we have any beds?” is how we begin every single shift in the psychiatric emergency department at the Hennepin County Medical Center.
Being a psych nurse at HCMC is like working a commodity trader’s desk in the Chicago Mercantile Exchange. Supply fluctuates hourly, and demand is always brisk. Yet the number of beds available at any moment dictates whether a mentally ill patient will be held in a cinder-block room for up to six days awaiting comprehensive treatment or sent to the medical emergency department or to other medical inpatient units.
Yet HCMC gets calls daily from desperate health care facilities as far north as Roseau, Minn., asking about psychiatric bed availability. The answer is almost always a resounding “no.”
The mental health system in Minnesota is in crisis. While routinely waiting to be transferred to inpatient psychiatry units, extremely acute patients may be held in restraints or in seclusion on and off for days, getting injected with high doses of antipsychotic medication to quell immediate mental health symptoms, while staff members scramble to meet their basic needs.
As a nurse in this department, I am troubled when I have to tell patient families that their loved one might not get optimal treatment for several days.
As HCMC searches for a new director of psychiatry, I am hopeful we can find constructive ways to improve the system, and that includes increasing budgets for mental health care. The current treatment is simply inadequate. Would we as individuals ever tolerate dayslong delays for a child or a relative with a severe medical illness?
Medical units also are affected when patients assigned to them must wait for a transfer to the psychiatric unit. Patients on legal holds for mental health may be handcuffed to their beds to ensure that they remain at the hospital prior to admission to psychiatric units for treatment. Staff members on medical units are not trained for dealing with highly acute psychiatric patients, nor are their physical spaces designed to ensure safe care, exposing vulnerable medical patients to increased risk and medical staff members to assaults.
The 2014 assaults on staff members at St. John’s Hospital, when a delirious patient attacked nurses with an IV pole, demonstrated what can happen when units aren’t designed for safety.
The experience of patients at HCMC, one of Minnesota’s largest hospitals with approximately 100 psychiatric beds, is typical for psych patients around the state. If anything, the situation in greater Minnesota is said to be even worse than HCMC, because facilities without inpatient psychiatry units must contact other hospitals and patients may wait days for psychiatric beds. Patients fortunate enough to be accepted to a psychiatric facility may then need to travel up to hundreds of miles for treatment.
Due to the pressure of demand for internal or external psychiatric transfers, hospitals with psychiatric units may also discharge patients earlier than is desirable, even patients who may not be entirely stable. When patients cannot get an inpatient psychiatric bed, their 72-hour hold may expire, the doors are opened, the handcuffs are released and little can be done thereafter to address their mental health problem. It becomes a question of not if the patient will return with the same symptoms due to substandard care, but when.
Because the mentally ill are our fellow citizens, the lack of beds on our psych units is not just a budget problem but also an ethical and political crisis. When patients are ready to be discharged from the hospital, few appropriate options exist for community placement. Patients may remain in the hospital for weeks because group homes, intensive residential treatment centers and other community facilities are full.
Just as some medical patients require transitional care before returning to independent living, some mental health patients require the same. The Minnesota Legislature increased funding this year for community crisis teams, but we have much further to go.
Fortunately, most of us will never be a patient in a psychiatric unit. Yet approximately 20 percent of Minnesota families have a member who experiences a mental health crisis at one time or another. I tell students who rotate through our unit that every one of us is just a series of tough-luck events away from being a patient in the mental health emergency department.
The state of our mental health system needs attention at the State Capitol — and around our dinner tables.
Karl Olson is a registered nurse in acute psychiatric services at the Hennepin County Medical Center.