Let Me Tell You About My Days

By last night, I felt like I was supposed to blog about this. Several people mentioned a book to me that was written by a Bellevue psychiatrist-- Julie Holland-- and an NPR Interview they'd heard. One pretty much convinced me I might want to actually read the book (reading about psychiatry isn't quite my idea of a leisure activity). So I get home and check my email: there's a link to the NPR page and interview about this book. There's an e-mail from Clink about how this is stuff kind of looks like the stuff from the book we're in the process of writing. I read a little of the Fresh Air piece and think, wow, this does sound kind of like our stuff. Sort of.
So go for it: Dr. Julie Holland writes about her work as an ER psychiatrist.
Okay, I only read a few paragraphs, and there was more of an edge to it than I want for our book.

For nine years, psychiatrist Julie Holland ran the psychiatric emergency room at Bellevue Hospital in New York City on Saturday and Sunday nights. Along with treating patients, she served as liaison to the medical ER and the toxicology department.

Holland says one of the hardest parts of her job was figuring out which patients were manic or schizophrenic and which were high on cocaine or methamphetamines. An expert on street drugs, Holland spent her college years researching and writing Ecstasy: The Complete Guide. Her new memoir is called Weekends at Bellevue: Nine Years on the Night Shift at the psych ER.

See what you think.

Shrink Rap: Grand Rounds is up at Health Business Blog!

Check out this week's Grand Rounds by David Williams at Health Business Blog.

Interesting topics include PTSD of being ill, Twitter discussion about remembering doc's instructions, and EMTALA and ER visits.

L.A. E.R. Tragedy . . . Emergency Mental Health Care

Connect the dots between these two stories...

Dr. Cory Franklin has a Commentary in the Chicago Tribune about this tragic story of a lady who died in an L.A. E.R. waiting room with bystanders calling 911 to help her because she couldn't get help in the ER.

Shortly after another bystander made a second futile 911 call imploring paramedics to take Rodriguez to another hospital, she died of a perforated bowel. A security videotape, still unreleased to the public, is said to show her writhing on the hospital floor unattended for 45 minutes. At one point, the tape reportedly shows a janitor going about his business mopping the floor around her.

. . .
This should be the audio of the 911 call... [removed due to misbehavior... try this link to listen: Youtube]


Mary Beth Pfeiffer in yesterday's Huffington Post discusses our broken mental health system.

In the 1990s, Virginia built 18 new prisons and closed 1,400 mental hospital beds. Across America, state spending on prisons spending tripled in the last 25 years while spending on mental health care rose by about a fifth.

And if you thought the era of shuttered hospital beds was over, consider that America lost another 57,000 psychiatric beds from 1990 to 2000. As a result, from 1992 to 2003, American hospital emergency rooms saw a 56 percent increase in people experiencing psychiatric crisis. It's time to stop the bloodletting.

Where is our compassion, our humanity, our duty?

Psych beds dropping like fish

According to yesterday's Science Magazine, we may lose the availability of sustainable fisheries by 2048 (see Scientific American: Overfishing Could Take Seafood Off the Menu by 2048). The article predicts total collapse of all world fisheries by 2048. "Total collapse" is defined as 90% depletion since the 1950s.

[prepare for non sequitur]

We have also been rapidly losing the availability of psychiatric beds for folks in need of acute inpatient hospitalization for mental health problems like major depression, bipolar disorder, and schizophrenia. In Where have all the psych beds gone?, I deplored the massive loss of inpatient psychiatric beds over the past 40 years or so. We used to have 20.4 beds per 10,000 population, and it is now down to 3.6. The numbers are now at about 18% of what they were previously. Another 8% to go before the U.S. hits "total collapse." Of course, there has been an opposite trend in forensic psychiatric beds, but I'll leave that for Clink to blog about (also see Hot Potato).

"Holy mackerel!" is right. People are boarding for days at a time in Emergency Rooms all over the country, waiting for a bed to become available. So, what's the current state of affairs? Check it out...

Pennsylvania State Hospitals Cutting Beds: NAMI President, Dr. Suzanne Vogel-Scibilia, as well as other citizens, petitioned the governor to halt bed closures. "'We ask this because of current inadequacies in community resources and the lack of a statewide comprehensive plan for closure and placement,' the petition reads."

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Florida Community Loses 16 Beds: Citrus County now has no psychiatry beds. Hospital officials say the beds were not needed. "But mental health advocates say Florida faces a shortage of inpatient psychiatric beds. The state received the lowest score possible in terms of access to inpatient services, according to a recent study by the National Alliance on Mental Illness. 'There are about 3,000 more beds needed in the state,' said Sue Homant, executive director for NAMI Florida. 'My personal guess is the number is even higher than that.'" ... According to NAMI's Report Card, Florida scored an F in Infrastructure, 48 out of 50 in per capita spending on mental health (a whopping $37.99 per person), and was number 15 in suicide rank. Florida is floundering.

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Ohio Gaining Beds: "Mental health professionals say more beds are needed since a number of hospitals with psychiatric services closed or cut beds in the past decade."

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Connecticut ERs Filled to the Gills: 2-weeks in ER awaiting a bed is common [treating them in a unit takes less time than this].

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Let us know what is happening in your state (or country).