An ER Designed For Psych Patients
(Sound of doorbell, door opening)
When I arrive at the psych ER at St. Vincent Charity Medical Center, it’s a quiet, fairly routine morning.
But, as in any emergency room, that can change in a hurry.
About an hour in, my host, Dr. Leslie Koblentz, gets a call from the Cleveland police.
KOBLENTZ: They’re coming in with someone and they’ve alerted us that it could get very threatening and violent.
Her team goes into high gear…
KOBLENTZ: So I’m going to grab a pair of gloves…Do you have a spit-mask Gloria?...
…and they’re ready when their patient, Larry, arrives.
KOBLENTZ: He’s very disheveled. He’s sweating. He’s handcuffed. His pants are falling down and two police officers are literally holding him on each side to bring him in.
(Sound of staff calming him down while he shouts) KOBLENTZ: Pajama pants! NURSE: And a gown!
KOBLENTZ: We have some more security coming in to help. Any allergies Larry?
(Sound of indiscernible shouting)
Koblentz and her staff place Larry in a bed with restraints and he begins to calm down.
When a person has a mental health crisis in Cuyahoga County, there’s a good chance they’ll land here.
In Larry’s case, police were called to his group home, where they found him out of control, punching walls.
Koblentz says he’s a pretty typical patient.
KOBLENTZ: We get people brought in by nursing homes, by ambulance from other places, by the police—they see someone walking in the middle of the road, what are you going to do with them? They bring them to us.
Drugs are often involved; many with mental illness also struggle with an addiction.
KOBLENTZ: You need something, Larry? LARRY: Cocaine. KOBLENTZ: Larry, I don’t have any cocaine. LARRY: Oh you tricked me.
Once brought to St. Vincent, it’s Koblentz’s job to keep the patient safe—hence the restraints—and figure what, if any, mental illness may be at play.
KOBLENTZ: When we talk about mental health, it’s not just a person with a diagnosis of schizophrenia or bipolar. There are a lot of people who are walking around in our city, they’re professionals, they’re people from all walks of life who have a full plate. And in this day of many, many stressers, where people are losing jobs, people are very upset, we have trained staff here who are able to talk with a patient. We try to figure out—we try to get to the heart of it.
KOBLENTZ: I’m the doctor Larry. LARRY: Thank you, m’am. Thank you. KOBLENTZ: I’ll see you in a little bit.
St. Vincent’s is one of only two dedicated psych ERs in the state – the other is in Cincinnati - and Koblenz says there are only a handful in the country.
They’re expensive to run.
Most of their patients are uninsured, and they require a lot of time and attention.
Many hospitals do offer psychiatric care.
But psychiatrist Mark Munetz of Northeast Ohio Medical University, or NEOMED, says most ERs aren’t set up to handle urgent psych cases.
MUNETZ: Regular emergency rooms are really constructed for medical emergencies, trauma—and psychiatric emergencies are just qualitatively different in terms of what a person needs.
He says they need quiet space, trained staff and, most importantly, more lengthy care.
That’s something Koblentz and her team at St. Vincent can provide—they can keep patients for up to 3 days.
Then if the patient needs further inpatient care, they’re admitted to a hospital psych bed, either at a private facility or the state-run psych hospital.
Beds there are often in short supply.
MICHELSON: I think everyone in the community believes that we do not have adequate resources in the community for inpatient psychiatric care, and that makes the psychiatric ED at St. Vincent’s even more important because if patients can be stabilized in a shorter period of time, you know 48 or 72 hours and then go back to the community, that saves us those precious inpatient beds.
Many gaps still remain in the spectrum of care available to those with mental illness, but Koblentz isn’t shy about calling the psych ER something of a gem for the community.
KOBLENTZ: We never know what’s going to come in the door. Every patient that comes in has a story. And that’s who we’re here for.