As many of you know, I lost my husband almost one year ago on September 11th, 2018. It has been almost one year filled with sadness, anger and confusion. Lots of tears, lots of nostalgia, and lots of hope, strength and grace. Catapulted by the horrific intricacies of Danny’s death and the events surrounding it, I believe in my heart that I am meant to share his story loudly in order to help bring change. What I do choose to believe today is God led me to this path to find purpose in this pain.
The details within Danny’s story would make this blog entirely too long, but I will say this…there was wrongdoing at the hands of not one, but two doctors. There are several cracks in existing policies that Danny had slipped through. What we are doing now is not working, folks. It just isn’t.
Here are just a few facts for you (but trust me there are more):
1 in 8 ER visits are due to psychiatric crises in the US.
The number of patients presenting with psychiatric complaints in the ER has increased by over 50% since 2006 in the US.
Only about 16% of ER physicians report having access to an on-call psychiatrist in the US.
Approximately 50% of frequent ER users have a mental health diagnosis.
Approximately 70% of those with Substance Use Disorder have a co-occurring mental health diagnosis.
A 2017 government report discovered that ER visits increased by almost 15% from years 2006 to 2014. Of those visits in the same period, mental and substance use disorder crises increased by about 44%.
Between 1970 and 2006, state and county psychiatric inpatient facilities in the country cut capacity from about 400,000 beds to fewer than 50,000.
Since 2013, involuntary commitments in Virginia have increased by 294%.
Conclusions can be made that the need for mental health stabilization far exceeds existing resources. As the number of state and county psychiatric hospital beds continues to decrease, the country continues to witness the steady increase of psychiatric crises, including co-occurring diagnoses between mental health and substance use disorders. The federal Emergency Medical Treatment and Active Labor Act categorizes psychiatric crises as equivalent to medical emergencies such as trauma and heart attacks. However, psychiatric crises (especially voluntary admissions) continue to be treated as a minor issue. It is also important to note that according to Virginia Code, Substance Use Disorder is included in the definition of mental illness. Many individuals have to wait hours upon hours with the rest of the individuals in the main waiting rooms. This time provides significant opportunity for individuals who are mentally unstable and/or intoxicated to make erratic and irrational decisions, such as leave the premises and complete suicide, overdose, commit criminal acts, hurt themselves or someone else.
Crisis intervention and stabilization must be made more of a priority in order for the state and our country as a whole to improve our current system by providing a continuum of care. If we are moving away from institutionalized care and transitioning to more focus in the community, then we need the resources and the capacity to support these individuals at the crisis level. These individuals are landing on the streets, in jails, in institutions, and in morgues.
The real deal is many of the psychiatric emergencies in Emergency Departments can potentially be resolved without an admission to a state psychiatric facility if proper operations are in place. As I am working currently with legislators and community leaders, concepts to be potentially proposed include but are not limited to:
Separate waiting area/immediate diversion (calmer, differently structured environment) from moment of entry once medically cleared
Peer recovery specialist and/or other trained crisis worker to sit with patients and/or be present in waiting area
Prompt evaluation/assessments – maximum 2 hour wait time
Access to psychiatrist or licensed provider via telemedicine or other means
Case management or other properly trained professionals for referrals, scheduled follow-ups, and transfers (required minimum 3 referrals/resources)
In response to an overdose or other substance related emergency, the following operating procedures should be implemented: Comprehensive assessment to identify appropriate medical interventions and any secondary psychiatric and/or medical issues, take-home overdose prevention kit with naloxone, and warm handoff to certified peer or case management. Perhaps even an immediate introduction to pharmacotherapy with a follow-up. We cannot continue to “treat and street” these individuals.
These standard operating procedures for behavioral health crises would improve outcomes, save lives, reduce recidivism and yes…save dollars. I respect the complexities of it all, I really do. But after everything I have seen, witnessed and experienced, I have to speak up. And I am grateful that there are so many who are sharing their stories with me. Although these stories are incredibly unfortunate, these testimonies can help to make a difference for the future.
There’s so much more than what is mentioned above, but for the purpose of this platform, I will stop writing here. But what I will not stop doing is sharing, advocating and fighting for change in our system with the help of legislators, community leaders, and you. We can do better everyone. And I will continue to give Danny a voice beyond death so that he will continue helping others as he so passionately loved to do while here on Earth. I will do everything I can so that Danny’s Bill is passed.
Stay close. More will be revealed.
Written by: Julie Funkhouser, Co-Founder & CEO of The Recovery Connection