The Connection -Monthly Newsletter from GCEH

Grady Overwhelmed By Mentally Ill Patients

For the first time in its 116-year history, Grady Memorial Hospital is issuing alerts to the Atlanta medical community that it can't take any more mentally ill patients. Atlanta's safety-net hospital has tried to divert mental health patients to other facilities for much of the summer. The unprecedented move reflects the crisis in Georgia's public mental health system, Grady officials said. State-run psychiatric facilities, which often operate at or beyond capacity, have been taking fewer patients from other hospitals amid a federal investigation, officials said. That has created a worsening backup at Grady, where many of the sickest mentally ill patients must wait up to 48 hours for a bed, either within Grady or at another psychiatric facility. Other patients are released to the community where there are few appropriate services, Grady officials said.

On its 13th floor, Grady operates one of the country's largest psychiatric emergency departments, handling 15,000 to 16,000 emergency visits a year, including children in crisis. Police bring about 350 people a month to Grady's psychiatric emergency service. Others are brought by family members or come on their own. In the past, many patients have been transferred to state-run hospitals after being evaluated and stabilized at Grady. But those transfers have slowed dramatically as the state mental hospitals deal with their own capacity problems. Crowding at the state's Atlanta hospital, along with staffing problems, have put its patients in "immediate jeopardy" of physical harm, according to a recently released inspection report from the Centers for Medicare & Medicaid Services. Grappling with this chronic problem, state officials have diverted hundreds of patients at Georgia Regional Hospital/Atlanta to private facilities, at a cost of more than $2 million. But it still hasn't solved the crowding issue, the inspection report found. The saturation of Georgia's emergency rooms with mentally ill patients echoes a national trend: a shortage of psychiatric beds that forces people who need them, including children, to be "boarded" in emergency departments across the country, according to a survey by the American College of Emergency Physicians.

"The lack of access to psychiatric care is creating a very dangerous situation for people with mental illness and for emergency patients in general," said Dr. Linda Lawrence, president of the emergency physicians organization. The agency that operates the state-run mental hospitals said it gives Grady $8 million a year for providing mental health services to patients. "There's a growing number of people with mental illness in the state," said Dena Smith, a spokeswoman for the Department of Human Resources. "It's a shared problem. It impacts the hospitals, the sheriff's departments, the mental hospitals - it impacts all of us.
Like Grady's, the Atlanta VA Medical Center's psychiatric facilities have been full much of the summer.

Construction and renovation have temporarily reduced the VA's available beds from 40 to 24, said Dr. David Purselle, director of acute mental health services for the Atlanta VA. He said he hoped the service would be back to full capacity early next year. "If we don't have beds for people coming into the emergency room, we still accommodate them," Purselle said. "We still assess them and get them referred to the appropriate facilities."
Karen Waters, a vice president of the Georgia Hospital Association, said ER backups have not improved despite meetings with officials of the Department of Human Resources. There are not enough community services available to keep patients healthy, and not sufficient capacity in state mental hospitals, Waters said. As Georgia Regional/Atlanta has cut back on its number of patients, the backlog at Grady has grown. Grady, which has only 32 psychiatric beds, used to be able to send about 200 patients a month to Georgia Regional. That number is down to about 50 or fewer, said Dr. Andrew Furman, associate clinical director of psychiatry at Grady. As a result, Grady has averaged about 40 hours a week this summer under what is officially known as "diversion status," declaring to the rest of the medical community that it is full to overflowing and patients should be sent elsewhere. In general, patients showing up for emergency psychiatric care are sicker than in the past and more likely to need hospitalization, Grady officials said. A shortage of community services means patients often don't get care until they are severely ill.

Homeless advocate Alan Harris frequently drives people to Grady's psychiatric emergency room. "I talk to people repeatedly who wait two days or even longer," he said. "It's very common to wait all night and all day with no food. I take people down there . . . go back the next morning and most of the same people are still there waiting."