[Noozhawk’s note: This article is part of a Noozhawk special project for The California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School for Communcation & Journalism. On Thursday, Day 6.]
[Click here for a gallery of photos from the series.]
Dr. Chris Flynn was about two hours from completing a recent eight-hour shift at the Santa Barbara Cottage Hospital emergency room, but the majority of the cases he’d seen hadn’t been broken arms, wounds needing stitches or head injuries.
Of the 22 patients Flynn had seen that day, 16 involved what he calls “social failure” — people with untreated mental illness, drug addiction or both.
Flynn has been working at the Cottage ER since 1997, and said that “the level of desperation of social issues” is higher than it’s ever been.
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As an example, he pulled up the records of a young woman, a schizophrenic, who has visited the ER 99 times since the beginning of the year.
He said she doesn’t have the support at home to help manage her illness, and constantly ends up in the emergency room when her manic episodes begin.
“The bottom line is that she’ll go back to a family system that isn’t helping things,” he said. “Half of our ER is dedicated to mental-health or social issues.”
The model of acute emergency room care doesn’t work well for psychiatric patients, who are only seen by someone in the medical community if they’re deemed suicidal.
Once the threat has passed, they’re released back into the world, with no treatment and no follow up, Flynn said.
“We’re spending hundreds of thousands of dollars for a system that doesn’t help them get better,” he said, adding that the sheer volume of psychiatric patients is becoming a burden to the emergency room.
A third of the patients seen in the ER has no means of paying for treatment, so the Patient Protection and Affordable Care Act, which goes into effect Jan. 1, may help alleviate some of that financial burden.
As Medi-Cal enrollment expands under the new law, many people may qualify for preventive mental-health services for the first time, and many people who already have insurance may see coverage for some services and treatments that were not covered in the past.
For now, people with severe untreated mental illness remain a staple in the emergency room.
In the ER, bed turnover is key, and Flynn looked at the patient log and the column that shows how long patients have been there.
With patients who come in for more traditional ER causes, they’ll typically spend a couple of hours being treated before they’re released.
With psychiatric patients, that timeframe grows exponentially.
Flynn’s computer log shows patients being held in the ER for 46, 50, even 72 hours.
All the while, ER staff may be trying to get these patients moved to one of the 16 involuntary-treatment beds at Santa Barbara County’s Psychiatric Health Facility or to a similar facility in Ventura.
But many times those beds are taken, and if someone in the ER with a mental-health crisis has drugs or alcohol in his or her system, the patient will not be admitted to the county’s facilities at all.
“They’re very hard to place,” he said of the patients.
The floor Cottage uses to house psychiatric patients during their “holds” — which can be up to 72 hours, or until they are deemed not to be a threat to themselves or others — is not a therapeutic space, Flynn said, and patients spend their hours in the 8-by-12-foot rooms monitored by a nurse.
Several security guards also sit nearby in case patients become aggressive.
Untreated mental health overlaps with homelessness in many people, and that group may be one of the biggest to benefit from the expansion of the new health-care law in Santa Barbara County.
Ralph Barbosa, director of the county’s Health Care for the Homeless Program, said that more than 85 percent of the homeless people it treats as a part of the program will be newly covered under the expansion.
“This is the one area that it’s most profound,” he said of the new law.
Homelessness can range from someone who is chronically sleeping on the streets to someone who just lost his or her house and is staying on a friend’s couch, and Barbosa said the program sees anywhere from 4,500-5,500 unique clients a year.
Annie Lucier, a public-health nurse who works with Health Care for the Homeless, does street outreach in local parks and at places like the Salvation Army.
She says her “focus is medical, but oftentimes there’s a psych component” with the patients she sees. Lucier adds that she tries to triage or link them to services if possible.
Mental health continues to be a huge issue for the homeless, she said, as well as other medical problems such as diabetes and “general poor health.”
Because county mental health officials are focused on state mandates that say they must treat the most seriously mentally ill, “it’s a really high plateau to actually receive care,” Barbosa said.
Dr. Takashi Wada, director of the county Public Health Department, said the county has a responsibility to provide care for the severely mentally ill, including those covered by Medi-Cal.
Primary-care providers in the community are supposed to be able to help treat those who have mental-illness diagnoses that aren’t as serious.
But “there’s a huge gap between what primary care is comfortable treating and what the county can take on,” he said.
“Right now, when we see indigent patients, there’s no reimbursement. That becomes a financial challenge.”
With many indigent patients converting to regular Medi-Cal, the county should see a new reimbursement stream.
Under the new law, some benefits are expanded, such as for residential detox programs for people with addiction issues and for treatment at day centers.
That expansion may also help the same population, since many people with mental illness also struggle with substance abuse.
As with other medical problems, early treatment for mental health problems is key.
“Hopefully, a lot of those problems will be treated early,” he said.
— Noozhawk staff writer Lara Cooper can be reached at lcooper@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.
Other stories in the Safety Net series:
» Patchwork of Clinics Struggles to Keep Santa Barbara County Healthy
» Without Health Insurance, Many Put Off Critical Treatment
» Poor Children May Have Most to Gain from Health-Care Changes
» Health-Care Providers Face Significant Challenges Serving Uninsured
» Emergency Rooms Strained by Growing Load of Patients
» Demand for Services Expected to Jump with Affordable Care Act
