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Beyond the Stigma: Hospital ERs are no place to house the mentally ill

By SHAWNE K. WICKHAM
New Hampshire Union Leader

August 08. 2018 11:16PM
WellSpan Good Samaritan Hospital has created a separate behavioral health suite in its emergency department to provide a quiet place for patients experiencing a mental health crisis. (SHAWNE K. WICKHAM/UNION LEADER)



As the behavioral health crisis has worsened and the number of available psychiatric beds has dropped, hospital emergency departments have become de facto crisis centers.

It’s called “boarding,” this caring for patients with mental illnesses along with victims of car crashes, heart attacks and broken bones.

Elliot Hospital is the latest New Hampshire hospital making changes to its emergency department to provide a safer, calmer place to care for these patients while they await more appropriate beds elsewhere. Its newly expanded Psychiatric Evaluation Program (PEP) unit has six beds and a common room that can be used for group sessions or family meetings.

A glimpse into how the new unit may help such patients can be found 400 miles south of Manchester, in Lebanon, Pa.

Lebanon, a city of around 26,000 — the size of Londonderry — is confronting the same challenges around behavioral health and addiction as communities across New Hampshire.

In February, WellSpan Good Samaritan Hospital, part of WellSpan Health, opened a new behavioral health suite for patients who come to the emergency department in crisis.

Harry Padilla is director of clinical services for Good Samaritan’s emergency department, which was bustling on a weekday morning earlier this summer. “We can see anywhere from 140 to 220 patients a day,” Padilla said. “It’s not conducive for calming.”

Since last September, Padilla said, the population of behavioral health patients coming to his emergency room has doubled, with as many as 10 a day. He believes it’s the result of a “huge paradigm shift” as awareness of mental illness has grown. 

In response, the hospital created the new unit, separate from the busy emergency room, with specialized nurses and patient care technicians. The four patient rooms are painted in soothing shades of slate blue or sage green. Each room has a window, chair, bed and a TV enclosed in an unbreakable box.

The focus is on safety, from the recessed lights and sprinklers to the solid fixtures in the bathrooms that prevent someone from tying something around them and harming himself. Even the bathroom mirror is unbreakable; it’s made of shiny metal.




The new behavioral health suite at WellSpan Good Samaritan Hospital in Lebanon, Penn., has numerous safety features, including special door handles. (SHAWNE K. WICKHAM/UNION LEADER)

Patients are kept under close observation by nurses and “sitters.” If the patient is a child, parents are strongly encouraged to stay with them while they’re here, Padilla said.

“You can see an almost instantaneous change in them once they come from over there with all the hustle and bustle,” he said. “It’s easier to rationalize with them, and it’s easier to talk with them about what the plan is going to be for them.”

There’s another indication that the new unit is having a positive effect: a dramatic decrease in the amount of sedatives given to patients, Padilla said.

The unit also has a quiet room, devoid of everything but a bed, for patients who need more help to calm down. “We would just put them in there to try to lessen the stimulation,” Padilla said.

But it’s far removed from the seclusion rooms hospitals used years ago, Padilla said. “That’s like putting them in a jail cell,” he said. “They didn’t interact at all. They just locked them in a room until they exhausted themselves.”

“That’s barbaric,” he said.

His entire emergency department staff has gone through training in dealing compassionately with individuals with mental illness, Padilla said, “so they can learn it’s a disease, just like heart disease.”

The patients receive their regular medications, but there’s no treatment provided here. “We’re just trying to provide them a quiet, calm place to rest until their bed is found,” Padilla said.

And here’s a key difference between what happens to these patients at Good Samaritan, and the same population in New Hampshire. Padilla said adult patients typically stay in the quiet area for just a few hours before they are transferred to WellSpan Philhaven, a 103-bed behavioral health hospital 15 minutes away.

There’s a longer wait for children, Padilla said, due to a shortage of appropriate beds. And he’s seen a disturbing increase in the number of adolescents coming to the emergency department who are “suicidal or homicidal and they’re extremely aggressive.”

Padilla said true systems change will come when mental illness receives the same level of government funding and attention as other diseases such as diabetes and cardiac conditions. “We’re decades behind, and we just keep losing resources,” he said. “We’re not allocating the proper resources for mental health, in my opinion.” The ideal is integration of physical and mental health care, he said: “It’s well-being.”

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Beyond the Stigma, sponsored by the New Hampshire Solutions Journalism Lab at the Nackey S. Loeb School of Communications, is funded by the New Hampshire Charitable Foundation, Dartmouth-Hitchcock Medical Center, NAMI New Hampshire, and private individuals. Contact reporter Shawne K. Wickham at swickham@unionleader.com.


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