The treatment of mental illness in hospitals remains a severe crisis in this country – costing millions of dollars each year as well as countless lives lost or unjustly criminalized.
The Feb. 12 New York Times report, “When the Hospital Fires the Bullet,” and corresponding This American Life segment, “My Damn Mind,” dramatically portray the challenges faced by individuals and family members seeking emergency psychiatric care – and the tragedies that can follow when staff are not prepared to care for someone in crisis.
Alan Peon, like many individuals experiencing a psychiatric crisis, sought help at a local emergency room. He and his family rightfully expected trained mental health professionals to evaluate and treat his psychiatric emergency condition with compassionate, quality, culturally appropriate and timely care in a safe, nonthreatening environment – exactly what we expect when we seek treatment for any medical condition. Instead, he was shot in the chest and nearly died.
Before Alan Peon arrived at the emergency room, he had jumped from a second story and crashed his car into the hospital. He described his symptoms of psychosis to the medical team, and his family provided his history of bipolar disorder. However, Alan was not seen by a psychiatrist, prescribed psychiatric medications, or given a diagnosis consistent with his psychiatric condition while in emergency care.
Unfortunately, what happened to Alan Peon is an extreme example of common, troubling experiences told by individuals and family members seeking emergency psychiatric care. Too often, medical teams are inadequately trained in treating mental illness, resulting in key symptoms being ignored and mental health histories provided by family members pushed aside. Many patients in crisis who seek care at emergency departments are quickly discharged rather than fully evaluated by mental health professionals. Hasty releases can lead to untreated symptoms and run-ins with law enforcement, setting in motion the hospital-to-prison revolving door and the criminalization of mental illness.
In 2014, the National Alliance on Mental Illness (NAMI) surveyed those impacted by serious mental illness regarding their experiences with emergency departments. According to the results, 44 percent of individuals rated their experience as “bad” or “very bad,” compared with only 20 percent who rated the experience “good” or “very good.” The primary factors for how users rated their experience were whether staff communicated effectively and listed to the patient’s concerns; treated the patient with respect; provided information about community education or support groups; made the patient feel ashamed as a result of his or her mental illness; and the race of the individual seeking care.
Surveys conducted by NAMI California found similar stories, with family members and individuals reporting unsafe discharges, a void of mental health professionals in emergency rooms, difficulty establishing communication between medical staff and family members, and many hours spent waiting without any psychiatric treatment. The frequency of these reports should alarm all of us and spur those in positions of authority to act swiftly to mend these oversights.
The California Highway Patrol, BART Police Department and other law enforcement agencies across California are already taking significant steps to improve interactions with individuals in crisis and reduce criminalization of mental illness. It is time for hospitals to follow their lead. Hospitals should ensure that emergency departments have adequate mental health staffing, train all staff in de-escalation techniques, employ standard assessments and protocols to evaluate individuals for mental health concerns, document information from family members, and discharge individuals when appropriate and with adequate follow-up care.
People like Alan Peon and his family should be able to trust that a hospital is a place for healing, not harm.
Jessica Cruz, MPA/HS, is the Executive Director of NAMI California.