Mentally ill shouldn't be treated in ERs: civil rights panel

Hospital emergency departments need to do more to identify and transfer mentally ill patients to appropriate facilities for care, a new government report says, but it falls short of recommending how healthcare providers can address a continuing shortage of available inpatient beds in mental health facilities.

The U.S. Commission on Civil Rights recently published findings from the fact-finding body's March meeting that examined enforcement of the Emergency Medical Treatment and Labor Act, passed in 1986 to address the practice of patient dumping.

Among the issues addressed is the treatment of mentally ill patients who visit emergency departments, a practice the commission stated should be reconsidered.

“If an individual is suffering a mental health emergency—and the emergency is not accompanied by a physical health emergency—HHS/CMS should allow medical professionals to provide the individual with the option for treatment at a facility that specializes in mental health issues, instead of requiring the individual be cared for at a traditional emergency department,” the report stated.

The report also recommended changing Medicare reimbursement codes for state mental health facilities and other providers caring for mentally ill patients to alleviate the financial burdens on hospitals treating such patients in an emergency department setting.

The report called for a continuation of CMS' Medicaid Emergency Psychiatric Demonstration, a three-year, $75 million program established under the Patient Protection and Affordable Care Act to reimburse psychiatric hospitals for services Medicaid typically does not cover. Currently Medicaid does not reimburse psychiatric institutions for care provided to enrollees between the ages of 21 and 64.

In addition, the commission called for HHS and the CMS to develop protocols for the intake, evaluation, stabilization, transfer and discharge of patients with mental disorders.

But a key issue not fully addressed in the report is what to do about the shortage of available beds at many public mental health facilities, a problem that has led to cases of hospitals holding psychiatric patients within an emergency department as they wait for admission to a certified mental health facility.

The problem of psychiatric boarding has been seen across the country as states cut the number of beds in public psychiatric facilities for budget reasons. A total of 13 states closed 25% or more of their beds from 2005 to 2010, while some closed nearly half, according to a 2012 report by the Treatment Advocacy Center. Overall, the number of state psychiatric beds decreased by 14% during the same period.

“When states closed their mental institutions, they reallocated their mental health budgets,” the report found. “States do not provide adequate community mental health services and many states seek federal reimbursement under Medicare/Medicaid to supplant the states' original obligation to pay for this care.”

Follow Steven Ross Johnson on Twitter: @MHsjohnson