First responders

When police cope with the mentally ill

By ANNEMARIE SCHUETZ
Posted 6/9/21

MONTICELLO, NY — “Our police are repeatedly confronting people [whom] they have just brought up to the hospital,” said district attorney Meagan Galligan at the June 3 public safety meeting. “They’ve just brought them up, they’ve told the doctor, ‘This person’s in crisis, he needs help, he needs three days of treatment,’ and they’re immediately released. And that person is back on the street before the police officer is done writing the incident report at the station.”

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First responders

When police cope with the mentally ill

Posted

MONTICELLO, NY — “Our police are repeatedly confronting people [whom] they have just brought up to the hospital,” said district attorney Meagan Galligan at the June 3 public safety meeting. “They’ve just brought them up, they’ve told the doctor, ‘This person’s in crisis, he needs help, he needs three days of treatment,’ and they’re immediately released. And that person is back on the street before the police officer is done writing the incident report at the station.”

Garnet Health CEO Jonathan Schiller is willing to work with Galligan. “I appreciate his open-door policy,” she said.

Emergency department care for psychiatric problems increased 44 percent between 2006 and 2014, according to the Association of American Medical Colleges.

Police, Galligan has said, are often the first responders in a psychiatric emergency. Now, she added, “We are making a recipe for disaster. These people don’t want to see the police, but other people are calling 911 saying, ‘He’s dangerous.’ It creates a hostile situation, and we really have to tackle it. I don’t know if legislation’s the answer, or a policy change, but I do appreciate Jonathan’s willingness to engage in a dialogue.

“I will say, this is becoming a major part of the DA’s efforts,” she continued. The role isn’t just to prosecute crime, “but to deter it and to prevent it. And that’s not happening on the mental health side.”

Emergency departments aren’t always equipped to care for psychiatric patients

Psychiatric patients end up in the emergency room because there aren’t enough inpatient beds in psychiatric hospitals, the increase in opioid use means more disturbed people, and there aren’t enough outpatient resources, according to a blog post at Genesight.

Sometimes the patients get checked over and released back into the community, as Galligan said.

Here’s some context from the hospital side, from the Western Journal of Emergency Medicine, by Kimberly Nordstrom et al:

“The problem really starts much farther upstream. Insufficient funding for lower levels of care from basic community clinics to intensive outpatient programs, community crisis stabilization units and respite services fuels the crisis and leads patients to seek care in emergency settings. Of the respondents to the ACEP [American College of Emergency Physicians] survey, 23 percent replied they have no accessible community psychiatric resources and 59 percent had no substance abuse or dual-diagnosis patient services available. Absence of alternative placement options aside from admission is only one of many constraints facing patients.

“Other social factors contributing to delays for patients seeking care in the ED may include the lack of insurance or public insurance, hesitation of private hospitals in accepting un/underinsured patients, lack of ambulances willing to provide transport, time spent handling preauthorization from insurance carriers and other managed care hurdles, homelessness and difficulty in placing patients with severe psychiatric illness burden. Added to this public health systems deficit is the inadequate number of state psychiatric inpatient beds due to funding cuts, inpatient unit closures and bed reductions.”

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