behavioral health and ED

Meriwhen, ASN, BSN, MSN, RN · Nov 3, 2016

Not counting drug-induced psychosis, which usually resolves once they sober/clear up, or those who are temporarily suicidal/"psychotic" because they're just looking for a place to crash for the night....

It's probably because it's become increasingly more difficult for these patients to get appointments with mental health providers d/t funding cuts to mental health services, lack of available appointments and very long wait lists, and/or issues with insurance (almost all of the psych patients I see in the ED are Medicaid or uninsured). Neverminding that compliance with medications among psych patients is not the greatest either.

whichone'spink, BSN, RN · Nov 3, 2016

Goodness. As far as I can remember, psych patients have always flooded the ED. I worked a non-nursing job in an ED in one city, and a nursing job in another ED in another city. 25% or more ED visits are related to psych issues, and that's not counting drug abuse or alcohol abuse. This has been the trend for years, and it won't change with the broken mental health system we have in place. If we can even call it a system. I bet even tiny critical access hospital EDs get slammed with psych patients.

ladedah1, BSN, RN · Nov 3, 2016

Im not in the ED, but obviously they come through the ED to get to me... We do seem to be getting quite a bit more lately and -- whew, is it exhausting!!! Lol. Honestly, i feel like it tends to come in waves... we'll get a whole bunch several weeks in a row... then relatively few for a while. And some nights... when your whole assignment should be somewhere on the psych floor (that your hospital doesnt have) you wind up running like a chicken with your head chopped off and really WISHING that the SURG in med-surg had filled the unit. Then again, these assignments may seem half normal on the dayshift surface... but then the sun goes down...

Meriwhen, ASN, BSN, MSN, RN · Nov 4, 2016

Honestly, i feel like it tends to come in waves... we'll get a whole bunch several weeks in a row... then relatively few for a while.

I've found that the numbers of visits and psych admissions increase towards the end of the month, then roll back once a new month starts and they've received their benefit checks. I've also noticed fluctuations around the holidays: the place clears out before the holidays arrive, then as soon as the holidays pass, the patients come flooding back.

Over the last several years, I've seen it happen in multiple facilities on both sides of the country. Unfortunately, what you're experiencing isn't exactly new :/