With crisis centers overwhelmed, Bucks County changes how mental health emergencies are handled

Bucks County is no longer directing first responders to transport people experiencing a mental health emergency to only hospitals with affiliated crisis centers, after officials complained their emergency departments were overburdened.

Individuals now are taken to the nearest hospital emergency room for evaluation, stabilization and transfer to a psychiatric unit, under the new county protocol that took effect the first week of February.

The change was made after the three hospitals with crisis centers expressed concerns about inequitable distribution of individuals under involuntary commitment petitions coming into their emergency rooms, said Donna Duffy Bell, administrator of the Bucks County Mental Health and Developmental Programs Department.

“This is trying something, if it doesn’t work, we can pull it back,” Duffy-Bell added.

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Bucks County funds mental health crisis centers at Lower Bucks Hospital in Bristol Township, St. Luke’s Hospital in Quakertown and Doylestown Hospital, which historically have handled most psychiatric emergencies and involuntary commitments.

But any hospital should have resources in place to manage and process an individual under an involuntary mental health petition, Duffy-Bell said.

Last year, 1,657 involuntary commitment petitions — roughly 32 a week — were filed in Bucks County, a number that has remained fairly steady since 2019. Not all of the petitions were upheld after an emergency department evaluation, though, Duffy-Bell said.

An average of 35 patients with behavioral health emergencies are seen weekly in Lower Bucks Hospital’s emergency department, hospital spokeswoman Michelle Aliprantis said.

The average ER stay for an acute medical patient is hours, but patients with a mental health crisis can wait days in the emergency department for an open bed in a psychiatric facility, which strains ER capacity, Aliprantis said.

“The situation becomes problematic with the volume that the emergency department sees when we experience an influx of crisis patients, much like the rest of the nation is experiencing,” she added.

At St. Mary Medical Center in Middletown, crisis workers have been present in the emergency department since prior to the protocol changes, and no adjustments were necessary, said Dr. Darin Geracimos, chair of emergency medicine.

The hospital was unable to provide the number of emergency department mental crisis workers, but Geracimos said the ER is able to handle any increased volume.

“We will continue to monitor the volume of patients in the region requiring crisis intervention and will make any adjustments necessary to meet the needs of our community,” Geracimos added.

Neither Jefferson-Bucks Hospital in Falls or Grandview Hospital in Sellersville responded to an email asking about their ability to handle more psychiatric emergencies. Grandview has hired a crisis worker in response to the protocol change, Duffy-Bell said.

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Outside mental health experts interviewed generally agreed that the priority should be on getting an individual evaluated quickly, even if it means taking them to a hospital that is not a crisis center.

“Failure to address a person in a psychiatric crisis has a far greater chance of leading to death or serious harm than a person with a sprained ankle who has to wait for treatment,” said Lisa Dailey, executive director of the Treatment Advocacy Center in Arlington, Virginia.

A more equitable distribution of patients who may need an involuntary mental health commitment makes sense to Jack Rozel, a past president of the American Association for Emergency Psychiatry.

Under federal regulations, hospitals are required to have trained staff and resources in place to handle basic assessment and stabilization for patients experiencing psychiatric emergencies.

A patient could be evaluated at a general hospital to rule out a medical condition that could be amplifying psychiatric symptoms, and, if necessary, transfer the person to a hospital with a crisis center where there is more expertise once the patient is stabilized, he added.

“I don’t think it's an unreasonable decision at all,” said Rozell, who is the medical director at Resolve Crisis Services in Pittsburgh.

But Elizabeth Sinclair Hancq, director of research for the Treatment Advocacy Center, pointed out that emergency departments are not designed for someone experiencing a psychiatric crisis, who may have an aversion to bright lights and loud noises.

“That is exactly the reasoning for psychiatric and mental health facilities,” she said.

Crisis centers provide other advantages beyond physical environment including on-site psychiatric staff and trained staff who know de-escalation techniques and who have experience not only addressing the crisis, but then engaging the person into the next treatment steps, Sinclair Hancq said.

She added it makes sense that hospitals are feeling overwhelmed because of the huge surge in demand for mental health crisis services nationwide. The bigger concern for her with the protocol change is that it is evidence of a systemic issue in Bucks County and a lack of available services.

Martha Stringer, whose adult daughter Kimberly, 30, has mental illness and a string of involuntary mental health commitments, worries whether hospitals will have adequate supports and beds in place to handle patients until they are stabilized or an open bed in a psychiatric facility is found.

Psychiatric emergency admissions typically are transferred immediately to a locked behavior health unit away from the regular emergency room. If a psychiatric patient is sent to a medical floor a crisis worker will need to stay with that person, Stringer said.

“I don’t know that they are really addressing the problem. It sounds like a Band-aid,” Stringer added. “It speaks to the fact that we need more crisis intervention centers.”

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This article originally appeared on Bucks County Courier Times: Why Bucks County changed where it's sending psychiatric emergencies