Misguided Solution

Misguided Solution

Lawyers ignore what they dislike and emphasize what they like. Susan Stefan
says, "there are no state rules limiting or even regulating the use of
restraint, seclusion, handcuffs, or forced stripping in emergency departments."
(Susan Stefan, "Wrong place for mental-health care," Boston Globe, November 7,
2007)
State and US discrimination laws protect persons with disabilities. They
include Mass General Law Chapter 151 B; the Rehabilitation Act of 1973, and the
Americans with Disabilities Act of 1990. Stefan does not believe that these laws
apply to persons accused of psychiatric illness. But she is wrong. Her argument
would create a new bureaucracy. It is good for human services corporations.
Supporting a new boondoggle she says, "The answers are out there; the
question is whether the will to implement them exists." I agree. Use the
discrimination laws to stop the abuses. Stop treating people with disabilities
as patients instead of citizens with rights. If lawyers would respect persons
with disabilities these abuses would end. Instead they promote businesses for
more treatment and more abuses.

Roy Bercaw, Editor ENOUGH ROOM

Wrong place for mental-health care
By Susan Stefan
Boston Globe
November 7, 2007

HOSPITAL emergency departments are among the least appropriate and most
expensive places in Massachusetts for patients in psychiatric crisis. Yet these
departments are where police, families, group homes, nursing homes, and others
routinely take people who are agitated, panicked, or threatening to hurt
themselves. Emergency departments are also where people go at the end of the
month when their medications run out, when their primary physicians can't see
them for two weeks, when they are frightened or desperate and have nowhere to
turn after 5 p.m. and their therapist's answering machine tells them to go to
the emergency room.

Emergency departments and these patients in crisis are both victims of a
healthcare system that increasingly relies on emergency care to cover gaps in
basic mental health and social services. Once at the emergency department,
psychiatric patients wait twice as long for help as other patients, often in
escalating frustration. Their interactions with harried staff, who often have
little mental-health training and resent the long-term occupation of emergency
beds, can make matters worse. Emergency departments don't have much time to
provide reassurance, and often resort to restraint and seclusion - sometimes
even handcuffs and pepper spray. Many psychiatric patients recount harrowing and
traumatic experiences: As the Globe reported this summer, psychiatric patients
sometimes die and have bones broken in emergency departments. They are often
stripped of clothing and left for hours.

This has to stop, for all our sakes: the emergency departments, people with
psychiatric disabilities, and taxpayers who pick up the tab.

This problem isn't restricted to Massachusetts. Recently, Rhode Island's
mental-health advocate sued the state, arguing that involuntary detention in
nontherapeutic emergency rooms for days without treatment violated state
constitutional and statutory obligations. A few months earlier, advocates in New
York filed a far-reaching lawsuit to end emergency department overcrowding and
mistreatment at King's County Hospital Center.

In Massachusetts, advocates and patients have sought help from the Legislature.
In September, Massachusetts lawmakers heard witnesses tell horror stories of
their experiences in emergency departments, sometimes after going there just for
medical care. Bills filed by Representatives Ruth Balser and Peter Koutoujian
would authorize regulations to protect people with psychiatric disabilities in
Massachusetts emergency departments.

This legislation is desperately needed. Currently, there are no state rules
limiting or even regulating the use of restraint, seclusion, handcuffs, or
forced stripping in emergency departments. The public health and mental health
departments, however, opposed the legislation, stating they would instead work
with hospitals to voluntarily improve the treatment that people with psychiatric
disabilities receive in emergency departments. We hope that these promises will
yield concrete improvements; publicly available statistics about restraints of
psychiatric patients in emergency departments (as is required of all inpatient
psychiatric units) would be a good first step.

Yet while changing emergency department practices toward psychiatric patients is
essential, it is equally essential to prevent as many of these emergency
department visits as possible.

Yet the state could well take a step in the wrong direction. Proposed
regulations by the Department of Mental Health would allow people who need
psychiatric evaluations to be sent to emergency departments. A better option
would be to increase mental-health services for people with psychiatric
disabilities. This could include emergency service workers who provide crisis
evaluation in the community; nighttime crisis services; and crisis beds outside
emergency departments. Helping patients get to medical appointments, find
primary-care doctors, and pay for medication would be more cost-effective and
less traumatizing for patients than a visit to an emergency room.

Emergency departments were never meant to be a home for the most difficult
clients of exhausted and underfunded social service agencies. People with
psychiatric disabilities need a better option. The answers are out there; the
question is whether the will to implement them exists.

Susan Stefan is director of the National Emergency Department Project at the
Center for Public Representation.