Risk managers unanimous on behavioral health crisis


A unanimous 100 percent of readers surveyed by Healthcare Risk Management Review say that the risk management issues around treating patients with behavioral health (BH) issues are a growing problem in their organizations.

Survey respondents noted that patients spend hours in the emergency department (ED) waiting on bed placement, and that there is often ineffective placement for mental health patients with violent tendencies.

“State mental health facilities do not have enough space for these patients,” noted one respondent. “This places hospital ERs and critical care units in jeopardy due to violent behaviors toward staff, patients and visitors.”

Several commented that the decreased number of inpatient beds at psychiatric facilities has been an issue, often causing the boarding of BH patients in hospitals’ emergency departments. As well as being an unsuitable environment for most behavioral health patients, this results in increased wait time for other ED patients.

Economic and societal trends were also seen as a factor in worsening the crisis: a lack of outpatient resources, increased drug use, and drug seeking behaviour were all highlighted as issues.

A respondent based in a rural area reported that there are not enough mental health professionals in that area, and they utilize telemedicine for psychiatry.  

A common theme among respondents was that facilities and treatment options are very limited for patients with behavioral health needs and as such, the responsibility for looking after them often falls on emergency departments.

“As an acute tertiary care facility with only one BH unit, we are constantly faced with the challenge of keeping patients and staff safe while providing outstanding care,” said one respondent. “I'm proud of the work we do in that regard, but feel as though ‘something has to give’ in a culture that does not prioritize mental health care.”

A related problem, added another respondent, is that patients with severe mental health issues may not understand the severity of a medical illness and do nothing to treat that medical issue – meaning that they may become seriously unwell before getting treatment.

Healthcare Risk Management Review, US