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Without Doctors Or Insurance, St. Louisans Visit The Emergency Room For Mental Health

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Gaps in access and long wait times mean patients are visiting the emergency room more often for mental health problems.

A growing number of people in the St. Louis region are seeking mental health treatment in hospital emergency rooms, according to a recent report from the St. Louis and St. Louis County health departments.

The report’s authors found the rate of people seeking mental health care in emergency rooms increased more than 40% in both the city and the county between 2010 and 2016, indicating people can’t get access to long-term care for chronic issues, health officials say.

Some patients seek treatment in the emergency room because they do not have health insurance. Others go to the ER because they cannot find psychiatrists, social workers or counselors. For many, the only available option is the emergency room — not an ideal setting for mental health treatment, doctors say.

In 2016 in St. Louis County, nearly 18,000 people visited emergency rooms for mental health-related reasons, or a rate of 188 per every 10,000 residents — an increase of 40% since 2010, according to the report. In St. Louis, the count numbered more than 11,000 patients — a rate of 348 per 10,000 people, or a nearly 50% increase over the same period.

“I think we’re seeing people who just have no other access to mental health resources,” said Evan Schwarz, an emergency physician at Washington University School of Medicine. “It’s really tough, because you want to help them, and you just know that the emergency department is not the best-equipped environment for them.”

Nearly 21% of county patients and 26% of city patients were uninsured, according to the report.

Even when patients have coverage, many insurance networksexclude mental health providers

There aren’t enough doctors to treat all the patients who need help. That means patients have to make multiple appointments with several providers before they can get regular psychiatric care. Even when people have great insurance, it can still take months to see a professional, Schwarz said. 

That lack of providers affects patients even after they seek help in the emergency room. Without enough places for patients to go, many end up in the emergency department for hours or sometimes days waiting for a hospital bed or spot at a mental health clinic, said Vijai Chauhan, an emergency physician at SSM Health St. Louis University Hospital. 

“It ends up being a safety net,” Chauhan said of the emergency room. “For many reasons – not having access to private physicians and an inability for a patient to desire to wait.”

On any given day, 30% to 40% of the patients in the hospital’s emergency room are there for mental health-related reasons, Chauhan said.

The one-time treatment given in emergency room departments, even at the best hospitals, is often incompatible with the treatment needed to treat mental health problems, said Jennifer Snow, public policy director at the National Alliance on Mental Illness. Illnesses such as depression, addiction and schizophrenia often require regular doctors’ visits to monitor treatment and provide counseling or other types of therapy, she said.

“We need to make mental health care more accessible so people can get treated before they get to a situation where they are in crisis and have nowhere else to turn other than go to the ER,” Snow said. 

But that kind of treatment can be almost impossible for some people to find, she said. Often it takes weeks or months to get an appointment with a mental health counselor. In the meantime, they’re left at risk.

Mood disorders such as depression or obsessive-compulsive disorder were the most common reason for patients to come to the emergency room in St. Louis County. They were also the most common reason for visits by women in St. Louis. St. Louis males were most likely to have psychosis, delusions or schizoaffective disorder. 

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Sarah Fentem is the health reporter at St. Louis Public Radio.