Psychiatric patients wait in ERs for days and weeks as inpatient beds are scaled back

One day in October, Rena Dubin got a call saying her 15-year-old daughter, Mia, who has Asperger’s syndrome and an anxiety disorder, had a panic attack so severe it caused her to run from her school building in Reisterstown, Md., and toward a busy road.

Confused and delusional, Mia was taken to Northwest Hospital in nearby Randallstown, the closest emergency room, where her mother hoped she would be swiftly transferred to a hospital that accepts adolescents for psychiatric inpatient treatment.

(Linda Davidson/The Washington Post) - Rena Dubin, right, at home with her child Mia Dubin.

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Instead, they waited. For nearly 24 hours, Mia lay on a gurney in Northwest’s emergency department. Finally giving up, the Dubins checked Mia out and drove her to Johns Hopkins Hospital. There, they waited in the emergency department for another day until Hopkins staffers tracked down an inpatient bed for Mia at Children’s National Medical Center in Washington.

“We just felt like we were in a holding pen,” Dubin, who lives in Columbia, said. “I was the one taking care of her in the ER, but the whole reason we brought her to the hospital is because we feel like we need help.”

The Dubins’ experience is an increasingly common one nationwide for psychiatric patients. The “boarding” of mental health patients in hospital emergency departments is a widespread problem that experts say is on the rise, in part because of cutbacks in inpatient hospital beds.

As states trimmed their budgets in the economic downturn, resources for mental health patients were among the casualties. Twenty-eight states and the District reduced their mental health funding by a total of $1.6 billion between fiscal 2009 and 2012.

Virginia, for example, eliminated funding for 19 acute care beds at the Northern Virginia Mental Health Institute in Falls Church in 2010, reducing the total from 129 to 110, though 13 have been restored through temporary funding. Restoring all19 beds permanently would cost $1.4 million a year.

Maryland lost 145 — or 12 percent — of its public psychiatric beds between 2005 and 2010, and Virginia lost 252 of its beds, or 15 percent, according to a 2012 report by the Treatment Advocacy Center, a nonprofit mental health group. The nonprofit says Maryland and Virginia have a “severe” bed shortage, with 12 to 19 beds per 100,000 people. The District wasn’t part of the report, but its mental health department said it increased its bed count by about 20 percent over the past three years, in large part because of the reopening of St. Elizabeths Hospital.

Meanwhile, more and more people are turning to emergency rooms for health care nationwide. ER visits increased by 32 percent from 1999 to 2009, and overall ER wait times for all sorts of ailments have also gone up, according to a Centers for Disease Control and Prevention report. Psychiatric patients make up 7 to 10 percent of emergency room visits, said a 2012 study in the Emergency Medicine International journal.

For many patients suffering from psychiatric crises, this translates to longer waits in emergency departments, where they receive no treatment for days — and sometimes weeks — while social workers try to chase down open spots in psychiatric wards, doctors said.