Helping ER physicians help the mentally ill

Photo illustration: Stephen Finn

California is long overdue to take steps, large and small, to address its homeless crisis.  No other state has a problem of this magnitude; a problem that disproportionately affects the mentally ill.  According to the office of Senate President pro Tem Kevin de Leon, D-Los Angeles, California accounts for 22 percent of the nation’s homeless total. That’s why the California Hospital Association has expressed its conceptual support for the “No Place Like Home” initiative, a package of bills drafted by de Leon and former Senate pro Tem Darrell Steinberg, that would leverage Proposition 63 money to fund supportive housing for Californians who are homeless and suffering from mental illness.

Building shelters is an important answer, but not the only one.  That’s why the California Hospital Association is teaming with the California chapter, American College of Emergency Physicians and the California Psychiatric Association to support Assembly Bill 1300 by Assembly Member Sebastian Ridley-Thomas, D-Los Angeles.  AB 1300, which faces a hearing in Senate Health Committee in mid-June,  is intended to replace outdated state law that causes substantial delays in connecting patients who show up  in the emergency room facing a mental health crisis with the care they need.

The bill removes a chokepoint that forces long delays for these patients, and eliminates a problem that compromises access to the emergency room for all patients.

Much to the frustration of ER physicians, their hands are tied when it comes to prompt assessment and referral for patients who arrive on a “5150” (involuntary) hold.  That is a reference to the state’s Welfare and Institutions Code that authorizes a 72-hour detention for patients who are believed to be a threat to themselves or others.

While public safety was the intent of the law signed in 1967, the reality is that it impedes timely treatment.  Patients must wait hours, even days, for a psychiatric specialist to arrive for an assessment.  That leaves these patients warehoused in a crowded emergency room; an undesirable environment for someone needing therapeutic treatment.

The problem is widespread.  On a daily basis in California, more than 800 persons are being held in ERs on a “5150” hold.  The vast majority don’t belong there, and could be treated through a community-based program.  Others need to sober up and then be released to the care of their families.

AB 1300 would give our well-trained emergency room physicians the authority to treat patients in mental health crisis with the same urgency as someone arriving with chest pains or a broken bone.  It would allow prompt decisions to be made on inpatient or outpatient care.  It would mean physicians could make important decisions on whether to impose or lift a “5150” hold.

The bill removes a chokepoint that forces long delays for these patients, and eliminates a problem that compromises access to the emergency room for all patients.  That’s good for the entire community.

AB 1300 does not represent a comprehensive solution.  In the bigger picture, California needs more resources for patients with mental health conditions, such as the permanent housing included in the “No Place Like Home” initiative.  In the meantime, AB 1300 represents an important initial step to restore clarity and consistency to the “5150” mental health hold process, and to remove roadblocks that currently prevent patients from receiving timely and appropriate treatment in hospital emergency rooms.

Ed’s Note: C. Duane Dauner is president and CEO of the California Hospital Association.

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