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L.A. County Releases Plan for Psychiatric Emergency Services Decompression

On June 8,2012 the County of Los Angeles released a memorandum detailing recommendations by Los Angeles County Department of Health Services (LADHS) and Department of Mental Health (LADMH) to address Psychiatric Emergency Services (PES) overcrowding.  Since individuals have been increasingly seeking assistance with psychiatric crises from the emergency department (ED), LADHS has been grappling with this issue as the primary PES provider in the county.  In Los Angeles, the County PES capacity is 39 beds among three hospitals (Harbor-UCLA Medical Center, LAC+USC Medical Center and Olive View Medical Center) but patient census typically necessitate 60-90 beds, reflecting the overcrowding issue[1]. For example, Olive View-UCLA Medical Center has 12 beds allotted to psychiatric patients in its ED but commonly houses 20 to 30 patients[2].  The crowded conditions make it increasingly difficult to de-escalate emotions of mentally ill patients who often come to the ED in very fragile and heightened mental states.

This issue has been exacerbated by state funding cuts for mental health, totaling $587 million between 2009 and 2011[3].  Acute inpatient psychiatric beds available statewide decreased by nearly one-third since 1996.  With fewer slots for psychiatric patients in specialized centers, psychiatric patients seek treatment at the nearest ED as the only 24/7 services they can obtain.  Often, hospitals do not have the resources to care for psychiatric patients. This leaves hospitals facing an increasing dilemma of finding proper facilities to care for psychiatric patients or releasing them back onto the streets. Since August 2011, LADMH psychiatric evaluation teams have been responding to emergency rooms for evaluation of mentally ill patients, only when they are not needed on “more urgent” calls.

PES overcrowding in LADHS gained advocate and media attention. In February 2012 a patient advocate sent a letter to county and federal officials and the Los Angeles Times, stating it was “dangerous and unsanitary” for patients to be sleeping on the floor and the hazardous conditions in the hospitals required immediate attention[4]. After an extensive assessment by LADHS and LADMH, the County developed a decompression plan focusing on three categories: reducing the inflow of patients, accelerating the discharge of patients and ensuring adequacy of existing PES facilities[5]. These recommendations aim to improve existing processes, address existing operational inefficiencies and acknowledge that the most effective use of additional funds is to add bed capacity at lower levels of care.  With estimated costs totaling $27 million over two years, LADMH has been able to identify someone monies to mitigate the costs; $13.0 million of one-time Mental Health Services Act (MHSA) funding. However, all current MHSA Community Services and Supports (CSS) funds are fully allocated, so LADMH has proposed to use a portion of the MHSA Prudent Reserve over a two-year period, in order to initiate implementation. In the meantime, the County is working to locate additional funds to sustain the plan.

The newly released plan for PES decompression is an important step in ameliorating this complex issue that will require public and private sector collaboration.

 



[1] William Fujioka, “Psychiatric Emergency Services Decompression Plan (Budget Deliberations, Agenda of June 25, 2012),” County of Los Angeles Chief Executive Office, June 8, 2012.

[2] Anna Gorman, “Crowding hampers L.A. County hospitals’ handling of mentally ill,” Los Angeles Times, February 11, 2012, Web.

[3] Anna Gorman, “ERs are becoming costly destinations for mentally disturbed patients,” Los Angeles Times, September 5, 2011, Web.

[4] Ibid.

[5] William Fujioka, “Psychiatric Emergency Services Decompression Plan (Budget Deliberations, Agenda of June 25, 2012),” County of Los Angeles Chief Executive Office, June 8, 2012.

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