One in three security breaches at hospitals in the Philly, Pa., area involved deficiencies in mental health services. How can hospitals improve?

A patient died on the floor of a behavioral health unit at the Hospital of the University of Pennsylvania’s Cedar Avenue facility because the staff didn’t know how to respond.

Children suffering from mental health crises were forced to wear lime green scrubs at the Children’s Hospital at St. Christophers in violation of their privacy rights.

A patient with schizophrenia and other mental health problems ran away from Crozers Taylor Hospital without her shoes or a working phone because staff did not monitor her closely enough after an earlier attempt to leave and was missing for six days

One in three safety citations issued to Philadelphia-area hospitals by Pennsylvania health inspectors since the beginning of 2022 have involved patients receiving treatment for mental health or behavioral problems. Hospitals in Philadelphia, Bucks, Chester, Delaware and Montgomery counties were cited 28 times, forcing hospitals to reevaluate how they manage their care.

Inspection reports reveal inadequate staffing, a lack of proper emergency protocol and insufficient training on how to help patients suffering from a mental health problem. These problems contribute to basic oversights, such as failing to properly screen and observe patients at risk of suicide and update their treatment plans.

Hospitals recognize that they need to serve patients better complex medical needs. In the Philadelphia area, several health systems have increased staff training. Others have installed specialized social workers in their emergency departments and added more psychiatric beds to meet growing demand for behavioral health services.

Patient safety advocates fear the problem will only get worse if hospitals don’t step up, said Carla Sofronski, executive director of the Pennsylvania Harm Reduction Network, a nonprofit that helps people access treatment for mental health and substance abuse.

It’s so important that, right now, more than ever, they get it, he said.

Complex medical needs

Hospitals have been challenged by an increase in emergency department visits by people experiencing a mental health crisis, said Jennifer Jordan, vice president of equity and behavioral health at the Hospital and Healthsystem Association of Pennsylvania. an industry group.

Many of the association’s 235 member hospitals across the state report seeing patients with more severe mental health problems, seeking treatment for a more complex mix of mental and physical needs, he said.

The number of people with mental and behavioral health needs has grown rapidly over the past decade, with around 22% of adults now suffering from some form of mental illness. Yet half don’t get treatment, either because they don’t know how to access care, are reluctant to seek help, or can’t find a provider with vacancies, according to the National Alliance on Mental Illness, a non-profit advocacy organization. of profit

The organization notes that people with a mental health problem are also more likely to suffer from cardiovascular and metabolic disorders, such as heart disease, stroke and type 2 diabetes. And about a third of people with a mental illness use drugs or have suffered from a substance use disorder, according to NAMI.

Many end up in a hospital in medical crisis. Symptoms can escalate, putting patients at risk of becoming agitated or aggressive, or leaving before receiving treatment, if staff don’t respond appropriately, said Sofronski of the Pennsylvania Harm Reduction Network.

Bright lights, loud noises and a lack of privacy in emergency departments can worsen symptoms for people with anxiety or depression, said Deborah Cunningham, vice president of behavioral health at Main Line Health, a nonprofit health system. with four hospitals in the western suburbs of Philadelphia. .

Being in a busy emergency department is really the worst place for them to be, he said.

Philadelphia hospitals also take in patients with substance use disorders who need treatment for deep, slow-healing wounds caused by xylazine, a horse tranquilizer increasingly found in street drugs. They may need to be treated with antibiotics for days or may require amputation.

READ MORE: Xylazine, the animal tranquilizer contaminating Philly’s opioid supply, causes serious injuries and withdrawal that many providers don’t know how to treat

Main Line Health expands services

Main Line Health is responding to increased demand by expanding specialty services for behavioral health patients. It is also training staff who provide more general care, such as in the emergency department, in how to recognize and respond to psychiatric emergencies.

Main Line doubled its number of behavioral health beds to 40 by 2022 in response to growing demand.

READ MORE: The Philly region has few beds for behavioral health patients and high demand

Main Line has also opened day programs, where patients can receive services during the day without being admitted to the hospital. Day programs are an alternative to intensive and inpatient psychiatric care.

In each of Main Lines’ emergency departments, a psychiatric clinical social worker is on duty around the clock to help quickly triage patients with behavioral health needs. The system owns Lankenau Medical Center, Bryn Mawr Hospital, Riddle Hospital and Paoli Hospital.

The goal of the system is to intercept patients with mental health needs before they become so urgent that they require emergency care, Cunningham said.

But even as the health system expands its mental health services, emergency rooms continue to see a steady stream of 40 to 50 such patients a week.

Thus, Main Line has increased training on how to interact with patients suffering from a mental health problem, how to de-escalate problems and what to do in an emergency. Each employee wears an identification lanyard with a button they can press to call for medical help.

We have to continually re-educate ourselves about what’s going on, Cunningham said.

Invest in people

Health systems need to invest in hiring enough staff to care for behavioral health patients and making sure they’re properly trained, as well as prioritizing the mental health of their employees, said Nito Gan, chair of Crozer’s psychiatry department. Health.

Crozer also wants to improve doctor-patient relationships to make hospitals safer for patients and staff. Patients who trust their providers will be less likely to become agitated and less likely to leave the hospital against medical advice.

Crozer has a 24/7 crisis center and last year opened an outpatient center for substance abuse and mental health disorders, both located at Crozer Medical Center -Chester to Upland. Gan wants Crozer to be known as a trusted and safe place for mental health.

We wanted to make sure we were doing everything in our power to get the word out that Crozer is the place to go for your mental health needs, he said.

READ MORE: Taylor Hospital cited after medically vulnerable woman goes missing for six days

Ongoing security issues

Inspection reports show what is at stake when staff are unprepared to treat patients with mental and behavioral health needs.

In January, an elderly patient with mental health issues walked out of the emergency department waiting room at Thomas Jefferson University Hospital and was missing for hours before anyone noticed. State inspectors issued one of the states’ most serious warnings after finding staff had failed to check on the 71-year-old nursing home resident every two hours as required.

Jefferson Einstein Hospital in Philadelphia was cited in early 2023 after inspectors found that five patients tried to harm themselves at the hospital because they were not adequately screened for suicide risk in the emergency department .

READ MORE: Nurses left patient to die at Penn Medicine hospital. State inspectors issued a stern warning.

A patient at HUP Cedar Avenues’ behavioral health unit waited four days for doctors to fix his broken wrist in November, after another patient died earlier that month. Inspectors and hospital administrators said diagnostic obfuscation, referring to providers dismissing a patient’s symptoms because of bias, could have affected care in both cases.

Penn gathered its top administrators to discuss how to address the diagnostic eclipse. People with a history of mental illness and the elderly are at greatest risk of having their concerns ignored.

Sofronski, who advocates for substance abuse and treatment of mental health disorders, believes hospitals should invest in ongoing staff education. Simulation training could help healthcare workers better understand how people with a mental health problem often feel misunderstood or judged when seeking help.

They just have to treat people with dignity and respect, he said, and think about how much it cost that person to walk through the doors.

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