10/31/2014

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Psychiatric patients being 'warehoused' at local hospitals

Psychiatric patients being 'warehoused' at local hospitals
SEATTLE -- Community health leaders insist we are in the midst of a public health crisis that most people have never heard of.

Behind hospital walls, there is a disturbing reality of too many psychiatric patients on hold for help.

Inside every community hospital in King County, mentally ill patients are being warehoused. Some are tucked into emergency rooms, put on medical floors and boarded in intensive care units for days, weeks and even months.

"When I say warehoused, I am saying we can keep them dry and safe and on their meds, but we are simply not equipped to provide the other care that they need to get better," said Dan Dixon Swedish Hospital's vice president of external affairs.

Those patients are known as psychiatric boarders. It happens when there are more psychiatric patients than psychiatric beds available.

"We have a public health crisis," said King County mental health director Amnon Shoenfeld.

Shoenfeld said state law requires individuals who are "gravely disabled" or a danger to themselves or others to be committed or hospitalized for treatment against their will.

Last year in King County, the Problem Solvers learned that 3,000 people were committed, and more than 2,000 of them had to wait for help.

"Basically, two out of very three people that we evaluate as needing involuntary commitment we can't find a hospital treatment bed at the time we do the detention. Two out of three, so that is a major crisis," Shoenfeld said.

Patients are committed for three days, but subsequent court hearings can extend that stay to 14 and all the way up six months.

Greg Bates is a nurse practitioner in psychiatry. He insists hospitalized mental health patients should be in a psych ward. Patients lucky enough to get a bed in a psych ward have access to specialized staff, therapy, activities and a locked down secured environment.

Bates said not every mental health patient is violent, but some patients are thoroughly psychotic and can be vioent.

Seattle RN Melissa Martin still has a hard time talking about what happened to her.

"I was fearful because he was so psychotic that he was going to kill me," she said.

Martin was trying to deliver meds to a psychiatric boarder when he charged her.

"Punching me multiple times in the face, eventually jumping on top of me where he continued to assault me and punch me in the face," Martin said of the attack.

Martin missed six months of work while she recovered from neck and back injuries, and she wasn't the only nurse who was assaulted.

RN Molly Murphy was at the mercy of her attacker until other nurses stepped in and rescued her.

"Beause at that point the patient did have my stethoscope and it it was around my neck and she was trying to tighten it," Murphy said.

In both cases the nurses insist they weren't properly trained to truly help their patients.

"As a nurse, I would never be floated down to the OR and expected to perform as an OR nurse," Martins said.

Federal, state and local funding cuts, as well as reimbursement reductions, the uninsured and disappearing community clinics all contribute to an uptick in warehouse patients.

Desperate for a fix, the county reached out to every hospital. Swedish wants to create a non-profit with other hospitals to pool their money and resources. Dixon said with guidance from Harborview Medical Center, 15 to 25 more psychiatric beds scattered in King County could be just the fix.

Swedish's board has earmarked money, but Dixon said at least three other hospitals need to commit.

"My friends will tell you I'm a dog with a bone. I want to get this done," Dixon said.

Staffers like Bates who worry about another tragic headline linked to mental illness are counting on it.

"Do we blame them for what they do or do we look at ourselves?" Bates said. 'And I think society is always judged by how do we treat the most disenfranchised."

Some patients eventually get a psychiatric bed and treatment, but the problem is statewide. Harborview gets the lion's share of the patients. It boarded 825 patients last year alone.

Area hospitals also say they're working with lawmakers on a fix.
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