Health Care

Emergency room wait times for Vermont psychiatric patients hit a high

ED Wait Time Graph

Vermonters with severe mental illnesses are spending more time in emergency rooms waiting for placement in psychiatric facilities than they have since the state began tracking the issue in the wake of Tropical Storm Irene.

On average, patients admitted involuntarily into the state’s mental health system waited more than two days in emergency departments during the month of May. The longest wait time was 330 hours, or 13.75 days.

The extent of the psychiatric system’s recent woes came to light Thursday at the legislative Mental Health Oversight Committee’s first meeting since the session ended.

“This is not a pretty picture,” committee chair Sen. Sally Fox, D-Chittenden, told acting Commissioner of Mental Health Frank Reed, as she clutched a graph of the trend.

Since August 2011, when Irene inundated the 54-bed state psychiatric hospital in Waterbury, officials and hospitals have scrambled to meet the needs of acute care patients. An increasing number of these patients are finding themselves in emergency rooms for days, and physicians say the level of care they receive is inadequate to treat their needs.

In April 2012, when the state’s data set begins, 10 beds were unavailable when adults needed them, and acute patients waited an average of 11 hours in emergency rooms. In May 2013, beds for 38 patients were unavailable, and the average wait time in emergency rooms rose to 51 hours.

State data shows that when beds are not available, patients wait two to five times longer to be placed in a psychiatric home than they do when beds are available. And these numbers do not include children’s mental health services, which legislators want the Department of Mental Health to account for in the future.

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Ray Keller, medical director at Fletcher Allen Health Care’s Emergency Department, said that a psychiatric patient recently spent 10 days in his department.

“That state hospital was sort of like the intensive care unit for psychiatric units,” he said. “We lost the intensive care for the sickest of the mental health patients and there are not an adequate number of beds to take care of them. We’re coming up on two years since we lost the state hospital. Never before did we have patients living in our emergency rooms.”

Mark Depman, director of Central Vermont Medical Center’s Emergency Department, agrees with Keller that the situation is getting worse, and he has the hospital numbers to prove it.

“Between June 2011 and June of 2012, we had 67 psychiatric patients stay in the ER longer than 12 hours, and 23 of them were held more than 24 hours,” he said. “In the last year, from June 2012 to 2013, we’ve had 105 people staying longer than 12 hours, and 45 were here longer than 24 hours. The number of people being held longer than 24 hours has doubled in the past two years, and of those individuals we’ve had 20 of them here for more than two days.”

What’s inconsistent about the rise in wait times is that new mental health facilities have recently come online. A temporary eight-bed acute care unit in Morrisville opened earlier this year, as did a new 14-bed acute care unit at the Brattleboro Retreat and a six-bed unit at the Rutland Regional Medical Center. Earlier this week, the state opened a seven-bed secure residential home in Middlesex.

“It’s counterintuitive,” said Rep. Anne Donahue, R-Northfield, who sits on the joint mental health oversight committee.

But Reed, in a separate interview, said that these new facilities don’t necessarily expand the state’s capacity to care for patients at the necessary levels.

“It’s not increasing our capacity as much as one would think because they were trying to provide this care before the renovations were completed,” he said. “We still have bed shortages. And until we have the new hospital built with 25 beds, we’re going to continue to have a bed shortage for acute inpatient care.”

Those 25 beds, however, might be 16 beds when the new Berlin psychiatric hospital opens. That facility, combined with the Rutland and Brattleboro facilities, was meant to replace the 54-bed state psychiatric hospital with 45 beds. But legislators are considering outfitting the 25-bed Berlin hospital with 16 beds at first.

Fox and Donahue said that they don’t have enough information yet to determine that the state needs the facility to operate at full capacity, and the committee plans to wait until November before making a recommendation to the Legislature as to whether to equip the facility with 16 or 25 beds.

For Dr. Depman, however, the decision is a no-brainer.

“It’s got to be 25 beds,” he said. “And I just hope to God those are enough beds.”

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Andrew Stein

About Andrew

Andrew Stein is the energy and health care reporter for VTDigger. He is a 2012 fellow at the First Amendment Institute and previously worked as a reporter and assistant online editor at the Addison County Independent, where he helped the publication win top state and New England awards for its website. Andrew is a former China Fulbright Research Fellow and a graduate of Kenyon College. As a Fulbright fellow, he researched the junction of Chinese economic, agricultural and environmental policymaking through an analysis of China’s modern tea industry. He is fluent in Mandarin Chinese and has been awarded research grants from Middlebury College and the Freeman Foundation to investigate Chinese environmental policies. A member of Investigative Reporters and Editors, his work has also appeared in publications such as the Math Association of America’s quarterly journal Math Horizons and Grist.org. When Andrew isn’t writing stories, he can likely be found playing Boggle with his wife, fly fishing or brewing beer.

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