Mental health patients face increasing ER wait times amid COVID and statewide psychiatric bed shortages

WILMINGTON, NC (WECT) – The pandemic has exacerbated the already critical emergency room wait times faced by patients in mental health crisis.

It’s an issue that weighs heavily on the hearts of countless patients and families, and it’s also an issue that impacts healthcare costs for all of us.

According to the NAMI, one in eight emergency room visits is related to mental illness or addiction, accounting for up to 12 million visits per year.


It’s been months since a young UNCW student was involuntarily institutionalized after her depression spiraled out of control.

Involuntary commitment is a legal intervention used to obtain care for people when they are considered a danger to themselves or others. Once the paperwork is filed in North Carolina, law enforcement usually finds the person, then transports the patient to the hospital for evaluation and placement in a psychiatric bed at the appropriate facility.

Law enforcement was sent to the 20-year-old’s dormitory in November after she attempted to kill herself by jumping from the roof of the building.

His bruises have healed, but the emotional scars are still there.

She is in therapy and has a job, but says she will never forget waiting in a dark room in the hospital emergency department for three days before a bed became available at a hospital facility.

“I heard people screaming outside, there were people sleeping in beds outside in the hallways. The whole hospital experience was honestly very traumatic,” said the student, who wished to remain anonymous. “I doubt I’ll make another suicide attempt or try to hurt myself again for fear of having to go back.”

It’s a story psychologist Hillary Faulk Vaughan often hears. Some of his Physician Alliance for Mental Health clients have conditions that require placement in public facilities like Cherry Hospital with much longer wait times.

“I believe the longest wait for someone in the ER was just over 30 days. We were working with the emergencies as best we could to get them the help they needed. The involuntary commitment has steadily increased,” said Hillary Faulk Vaughan.

The workflow for people waiting for mental health care is in some ways similar to going to the emergency room after breaking their leg. It’s the job of emergency personnel to stabilize your leg and then send you to a specialist like an orthopedist.

The difference is that people with leg injuries wait at home for the specialist. If you have been involuntarily interned, you cannot return home. You wait in the emergency room.

Staffing shortages and emergency departments inundated with COVID patients have exacerbated already long wait times. It’s a perfect storm that pushed wait times for a psychiatric bed from six days before the pandemic to an average of eight days during the pandemic.

The main reason for the delays comes down to the critical shortage of hospital care beds in North Carolina.

The Treatment Advocacy Center suggests that 50 psychiatric beds per capita are needed to adequately meet community demand. In 2020, DHHS confirmed that North Carolina had just 22.7 beds per capita.

The demand is even higher for facilities that see patients with histories of violent behavior, financial constraints, or complex medical needs.

Wait times are so long that it’s not uncommon for patients to stabilize enough for involuntary recognizance orders to expire and the person to be discharged from the ER to the streets, never having received treatment .

“Emergency department staff are doing their best to meet their needs within their capabilities and resources. Clearly, they do not have the staff or training to provide ongoing long-term therapeutic psychiatric interventions. What they do is work on stabilization. They get food, they get medicine, but you’re practically talking about being tied to a bed. There are no groups, there is no therapy,” Faulk Vaughan said.

Proponents worry that the lack of available psychiatric beds is both a patient safety issue and a risk to emergency room staff. All of this adds up to a high degree of need and limited resources.

“It’s so easy when the going gets tough it’s finger pointing, but what we know about this system is every step of the way, whether it’s an outpatient provider , emergency room staff, inpatient psychiatric facilities – private or public – they are made up of people who are caring and doing their best,” Ms Faulk-Vaughan said.

The wait for those limited beds is a problem that every link in that chain agrees needs to be solved, including people, like the 20-year-old UNCW student, who have been through the system themselves.

“I try not to blame anyone, but if people who need – really need – help are being treated like this… I’m sure there are cases like mine where we were just having a bad time and we just needed someone to help us get back on our feet,” the young woman said.

In Thursday’s Top of Mind: Focus on Mental Health Part III, we discuss what is being done to help fill the gaps and share details about an inspiring project kicking off this week in the Cape Fear area.

Copyright 2022 WECT. All rights reserved.

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