Studies are now recognizing patients who might be habitually seeking treatment in emergency rooms with symptoms stemming from mental disorders.
As the name suggests, emergency rooms were supposed to be for emergencies. By emergencies, one can mean a health condition or event that requires immediate medical attention or one that can turn life-threatening in no time. However, emergency rooms are changing fast. Today these rooms are the first stop for patients who have nowhere else to go. In a lighter vein, it is not uncommon for emergency rooms to see patients coming with non-emergency complaints such as stubborn coughs or unexplainable stomach aches and headaches that never find a physical diagnosis.
Emergency rooms essentially don’t work like clinics. These rooms don’t work on the principle of first-come, first-served. The room works on the principle of giving priority to the sickest patients. It means that if you are required to wait in an emergency room, you probably don’t need immediate medical attention and there are more sick patients than you in the room.
It is not uncommon for emergency doctors to identify the ‘frequent flyers’ who might be visiting the room frequently with similar symptoms and leaving with no conclusive recovery plan. Many times, these patients are those suffering from mental disorders, having somatic symptoms and going undiagnosed for months or even years.
The article is attempting to understand whether emergency rooms can provide relief to people approaching with psychological symptoms and do they get the same kind of attention and care that others having physical ailments might receive.
Who are these ‘frequent visitors’?
The position of emergency rooms in the present time is as confusing for patients as it is for healthcare workers who are working there. Emergency department (ED) overcrowding is an increasing public health issue and is particularly associated with rising healthcare costs, longer waiting times, longer overall length of ED- stay, decreasing patient satisfaction, and higher mortality.
Upcoming studies are now recognizing some patients who might be habitually seeking treatment in emergency rooms. Among these patients are those who might be primarily suffering from mental health conditions or even substance abuse. While emergency rooms can help them with the physical aspect of mental illness (for instance, injuries due to self-harm), there might also be a need to undertake specialized care. Many times, patients might not seek specialized care (like visiting a mental health specialist) and this might end up in them returning with similar symptoms to the emergency room after some time has passed.
As per reports, many people having mental disorders end up visiting emergency rooms frequently. For instance, a panic attack can be mistakenly perceived as a cardiac event and the patient might be asked to go for tests like EKGs or ECGs to confirm the diagnosis. According to experts, mental disorders can also pose life-threatening situations like injuries caused by self-harm and they can in no time become serious medical emergencies.
However, amid the existing bias against mental disorders as a subsidiary of physical health and contemporary problems like overcrowding of emergency rooms, lack of resources and limited healthcare force, this problem becomes more complex than it usually appears.
To provide clarity on the subject, the Health site spoke to Dr Rishi Gautam, MD – Assistant Professor of Psychiatry, GWU School of Medicine (Washington, DC).
Here are some excerpts from the interview-
Talking of India, do you think that more people are visiting ER for symptoms that turn out to be psychological than physical?
Answer-It is quite challenging to get a good sense of the volume of ER visits related to mental health concerns without focused research on it. There is a dearth of that information. The National Mental Health Survey (2016) and other studies point towards the increasing prevalence of mental health conditions in India across all age groups, so it would not be surprising if this translates to increased emergency department admissions.
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Patients can confuse panic attacks with heart attacks. They might also be asked to go for tests like ECG. How common is this scene in Indian ERs and does it increases the burden of tests in hospitals?
Answer- Panic attacks present with symptoms like shortness of breath, chest tightness and chest pain, anxiety, and sweating mimicking signs of acute coronary syndrome. The first approach will always be to rule out acute cardiac disease, especially in patients with no known psychiatric conditions. This will certainly lead to an increased number of EKGs and other testing being ordered.
Are specialists in ER trained well to understand, empathize and tackle psychological emergencies? Answer- Specialists in ER are Doctors who have received education in Psychiatry and mental health. That said, there is certainly room for increasing awareness about trauma-informed care and managing psychiatric emergencies.
Could psychological emergencies be as serious as physical ones?
Answer– Yes. Psychological distress often presents in physical forms. For example – stress headaches, broken heart syndrome which is also called Takutsobo Cardiomyopathy, pseudocyesis, and functional symptom disorder amongst others. These are conditions where psychological distress causes measurable physical impairments.
Patients having psychological symptoms often face humiliation in emergency rooms where their symptoms might be discounted or taken as subsidiary to physical symptoms. Should psychiatric crises be taken more seriously?
Answer- Certainly, there is an opportunity for us to prepare emergency department clinicians to take better care of patients presenting in a psychiatric crisis. Mental health conditions are medical illnesses. They cause immense morbidity and suffering and deserve the same attention as any other reason for which someone may need to access emergent medical care.
While doctors prioritize patients in ER as per the seriousness of their condition, for patients it is hard to perceive their condition objectively and might show impatience
Answers– As clinicians, we take care of the patient, not the illness. This approach enables patients to have a better understanding and then control over their recovery. Education with this approach helps.
Are ERs competent in handling psychological emergencies?
Answer-Absolutely, yes. Some common mental health or psychiatric emergencies include acute suicidality or self-harm intent, severe psychosis, bipolar disorder, catatonia etc. These conditions require emergent attention and ERs need to be equipped to take care of them. There is a very high risk of loss of life if these go unattended promptly.
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