WASHINGTON, D.C.—Patients with mental health issues range from suicidal children dealing with bullying to aging World War II veterans exhibiting delirium. But emergency departments are dealing with them more and more so physicians need to pay attention, according to a panel at ACEP17.
“The problem is it’s not the right setting,” said Vikhyat Bebarta, MD, FACEP, one of three speakers at the interactive session, “ACEP Connect: Mental Health Patients in Your Department.” “We talk about wanting to see these patients in the right place, the right time—with the right team. And, unfortunately, we don’t always have the right team.”
Dr. Bebarta, professor of emergency medicine and medical toxicology and professor of pharmacology at the University of Colorado School of Medicine in Aurora, said that dealing with crisis stabilization requires, among other things, a detailed approach that addresses security (either via personnel or the use of alarms), caretaker education (periodic reminders on best practices), and the use of the best pharmaceutical options when necessary.
One pearl he emphasized is to always speak in calm and reassuring tones. It’s a technique that is just as useful for geriatric patients with mental health issues. Co-presenter Kathleen Walsh, DO, MS, a geriatric medicine specialist at the University of Wisconsin School of Medicine and Public Health in Madison, said that physicians should talk to older patients, particularly those with delirium, as they would speak to a family member.
“If a patient with delirium said to you, ‘I need to go get the kids from school’…you wouldn’t say, ‘Mom, you’re in the hospital, you’re not teaching any more.’ Don’t do that. What you say [is], “I know you need to get the kids, we will get to them in just a minute. Change it up a bit but don’t argue with them.”
The third panelist, Abhi Mehrotra, MD, MBA, FACEP, associate professor in the department of emergency medicine at the University of North Carolina School of Medicine in Chapel Hill, noted that the difficulty of not being able to discharge pediatric or geriatric patients with mental health issues means many end up boarded. And, while the lack of available bed space elsewhere is part of larger issue in health care, he said it’s incumbent on emergency physicians to work diligently to clear their emergency department.
“It’s not just the behavioral health patients that are impacted,” Dr. Mehrotra said. “It’s also the patients that come in for appendicitis, for COPD flare, for chest pains. It’s every single patient. So it helps to address the other boarding issues as well.”