LET'S TALK ABOUT HOPEFUL VOLUNTARY ADMISSIONS by Mary Irwin Butler

Let's talk about hopeful voluntary admissions. We have had four very long ER visits (5-14 hours each) in the last couple of months trying to admit my fear-filled, very psychotic son voluntarily. When my son gets to the point that he's asking to go to the hospital, he's beyond ill and fearful. He battles monstrous auditory hallucinations while he's in crowded waiting rooms with the elderly, sick babies, and patients with infectious diseases. It's horrid for him and potentially horrid for them.

No beds were available in the Philadelphia metro/suburban area within a 50+ mile radius. These four useless ER visits led to exacerbated illness resulting in an involuntary admission which is always more heartbreaking and exhausting. Unfortunately, in our locale, we cannot call or look for available beds on our own. It must be done in a local ER as follows: 

      *Long waiting room wait

      *Triage evaluation (psych patients are rarely prioritized) 

      *Back to the waiting room and possibly another long wait 

      *Med clearance including blood/urine tests, etc. 

      *Psych evaluation by social worker when available 

      *Insurance approval — usually a lengthy process

      *Bed search (typically hours/sometimes days) 

      *Clinical review/approval by the admitting facility if a bed is available 

      *Wait for available transport to the admitting facility

      *Lengthy wait/intake at the admitting facility whatever hour fatigued patient arrives

At times, very ill patients have been known to lay in ER beds from overnight to an entire week+ until a bed becomes available. How terrible that someone seeking mental illness treatment is left waiting so long. Imagine if this happened to someone with appendicitis or broken bones. Understandably, patients with serious mental illness become uncomfortable, frustrated, anxious, and further disturbed. They receive very little attention from ER staff unless they're acting out. Many, including my son, give up and walk out of either the waiting room or the examination room. The process is pretty much the same here for involuntary admissions. They involve the police, lengthy paperwork at the County Crisis Center, and legal approval. So tack on several more hours.  

I've mentioned to several ER docs and nurses, to no avail, that these critically ill patients should have a separate waiting area, be triaged expeditiously to an ER bed, and not be left alone for long periods of time. It's a cumbersome and careless system. The entire process needs to be streamlined and more efficient. It needs to provide timely access to safe and attentive emergency care and in-patient beds.

The mainstream media paint the picture that if only these mentally ill individuals would seek/get the necessary help, then we wouldn't see these ongoing mass shootings. That may apply to a few but truly no one, especially the media, has a clue as to the availability of mental health care, let alone timely/quality care, unless they've walked in our weary shoes. 

Bottom line: We're serving our seriously mentally ill in a very questionable and trepidatious manner, if at all. The availability of in-patient beds is in crisis. It's no wonder. Several of the better hospital psych units in this premier healthcare area have closed (not profitable) in lieu of expanding profitable cardiac units, etc. A crying and growing shame leaving personal and community tragedies in the making...

 Mary

Mary