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Hospitals Struggle to Serve Mental Patients; Finding Beds for Them Sometimes Takes Days, Health Care Officials Say

Posted on: Friday, 29 July 2005, 18:00 CDT

The Patriot Ledger

It's one thing to wait hours in the emergency room. Robert Stennis waited days.

Stennis, not his real name, went to South Shore Hospital in Weymouth last Thursday night when his bipolar disorder worsened.

The 35-year-old Hingham resident spent the next six days in a 10- by-10 room in the emergency department. On his hospital bed was a to- do list with his No. 1 task: "I want out of here."

Yesterday Stennis finally got his wish. South Shore found a psychiatric bed for him at Norwood Hospital and sent him there.

Although the man is willing to be identified, The Patriot Ledger is withholding his name because he is mentally ill.

Until yesterday, the hospital and the Quincy agency that evaluates mentally ill patients for its emergency room, South Shore Mental Health, had tried in vain to locate a bed for him.

Finding inpatient psychiatric care can be difficult for any patient, but it's even harder to land a bed for people without health insurance, like Stennis, officials said.

Tim Quigley, South Shore's vice president of nursing, said it takes two to three weeks to process an application for free care, the state program for the uninsured.

"This is a tough patient population," Quigley said.

Officials differ about the severity of the problem.

Lester Blumberg, chief counsel for the Department of Mental Health, said most emergency room patients do not wait long for psychiatric beds.

"From time to time an individual does become stuck because of bed availability and regional circumstances, but it is not frequent," he said.

Robert Gibson, the South Shore Mental Health official in charge of dealing with patients in crisis, said local emergency room patients who need psychiatric hospital care usually get a bed within four hours.

"Anything over 24 hours is unusual," he said.

Hospital officials, on the other hand, said patients are spending days in emergency rooms because it takes so long to find beds for them.

South Shore Hospital spokeswoman Peg Holda said the usual wait for mental patients there is two to three days.

"The availability of licensed facilities in our broad region for patients with serious mental illness is inadequate," she said.

Paul Wingle, spokesman for the Massachusetts Hospital Association, said, "We are hearing more and more about adult mental health patients getting stuck in hospital emergency departments. Not a day goes by without a hospital notifying us of the problem.

"It takes a lot of work to find out where the beds are," he said.

Hospitals are working with the state to establish an online service listing available psychiatric beds, updated twice a day, Wingle said.

Dr. Robert Beckhardt, a Hingham psychiatrist and family friend, took Stennis to the hospital at 11 p.m. last Thursday at the request of his parents.

"He got into a room in the ER at 2 a.m. Friday," Beckhardt said. "He's been there ever since."

Beckhardt said he is not criticizing South Shore Hospital, where he worked for 15 years. He said the staff who worked with Stennis deserve high marks.

"There are a lot of places that wind up in a situation like this," he said. "This is really a failure of the mental health system."

Beckhardt, who has known Stennis since he was 12, said he developed bipolar disorder early, but graduated from college and worked as a stockbroker. He was accepted to a master's degree program at a Worcester college and planned to start in September.

"He was getting his life together," Beckhardt said.

But Stennis stopped taking his psychiatric medicine about a year ago, the psychiatrist said. No one knew because people don't immediately show symptoms, Beckhardt said.

"In the last two months he developed mania," he said.

Beckhardt said that another time he would take a patient to Brockton Hospital, which has a psychiatric unit, or the Jordan Hospital in Plymouth, which has clinical psychiatrists on staff. He said he took Stennis to South Shore because he needed immediate attention.

"I was driving in a car with a psychotic man," he said.

Yesterday Stennis' room in the South Shore Hospital emergency department contained a hospital bed, a portable bed tray and a chair.

Stacks of paper filled with Stennis' notes were lined up on the mattress.

He had written his physical workout plan on one sheet: pushups, situps, "boxing spar 5 min" and deep knee dips.

A sturdy man with sandy-brown short hair, Stennis was wearing khaki green shorts with a blue-patterned hospital johnny and gray socks. "I pull the bed out to the center of the room and do laps," he said.

He calculated that he could run 540 feet in 30 laps around his 3- by-6-foot bed.

To pass the time, Stennis exercised, kept track of the days he spent by crossing out squares on graph paper, wrote his plans to get out, and telephoned his family, hospital officials, Beckhardt and The Patriot Ledger.

He insisted that he had not been seriously ill when he went to the hospital, but said he planned to keep taking his medication when he got out "to keep from going back here."

At the same time, Stennis said: "I don't have a good track record when it comes to being bipolar."

During a visit from a reporter, Stennis ate a cheeseburger and some salad. His tray also included french fries and apple pie. "The food here is excellent," he said.

But he said he had to knock on glass panels in his locked door to get the attention of security guards to accompany him to the bathroom, and he spent hours alone.

Robert Gibson, the South Shore Mental Health official in charge of dealing with patients in crisis, agreed that long emergency room stays can harm mentally ill patients.

"Sometimes services in the emergency room can get someone past the acute phase," he said. "But sometimes sitting in a bed waiting doesn't help anybody. It's not something anybody likes."

Beckhardt said South Shore Hospital needed a psychiatric unit to serve patients in its emergency room, one of the busiest in the state.

But Holda said, "It is an unfair burden on a busy ER to provide care for which we are not licensed."

In 2002, the hospital replaced psychiatric nurses who served emergency room patients with social workers working reduced hours. The hospital also contracted with South Shore Mental Health to evaluate patients. The hospital's medical director of emergency psychiatric services, psychiatrist Charles Morin, resigned in protest.

Sue Reinert may be reached at sreinert@ledger.com.

Source: Patriot Ledger, The; Quincy, Mass.

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