Cutting the Gordian Knot


Good morning, emergency department junkies. The rest of you too.

So, we’ve been talking for a month about the ED and mental health. Who shows up at the door, why they come, what they suffer from, how they are treated, and how they interact with the environment there. It’s true that you can’t know where you’re going until you know where you are.

In case you missed some of my previous loquacious musings, let me sum it up for you.

Mental health treatment in the emergency department is a mess.

How do we address this Gordian knot of court system, families, law enforcement, patients, social work, medicine, mental health, nurses, doctors, and health care facilities? Where to start?

Julie Andrews has the answer.

Let’s start at the very beginning.

A very good place to start.

1) Getting into the system is confusing, cumbersome, and downright terrifying for patients.

We’ve aready talk about families abusing the court system to get loved ones committed based on inaccurate information or even on malicious grounds. We’ve seen how hard it is, No Wrong Door notwithstanding, to figure out how to acccess the appropriate services when you’re depressed, hopeless, or psychotic.

2) Because of this, some patients never get started with the treatment they so desperately need.

They suffer in silence. Other patients’ first encounter with this complex system is so traumatic to them, so painful and degrading and humiating, that it becomes their last contact. They give up on getting help via traditional pathways. I have heard you comment on my blog, over at the Shrink Rap site, on Twitter and Facebook about this. I hear you. You’re right.

3) The trauma of gaining admission to the existing mental health treatment system is real.

You’ve also weighed in on this loud and clear. Just after one of my readers commented on the physical trauma of being manhandled into an ED, I saw a patient who had been tasered by law enforcement to subdue him before transport to the emergency department for a mental health evaluation. Do you think that patient will remember the caring and compassion he got in the ED, or the painful shock of being tasered to get him there? What will stick out in his mind? What will encourage, or hinder, him from coming back to seek help the next time he is ill?

Tomorrow, I will begin to share some of my thoughts about how we can do it better.

I will lay out some simple, some not so simple, changes that we could start making right away to streamline the entry into the mental health care system. I will welcome your reading, digestion and rumination on these changes. Then, I will also invite you to share these with family members, colleagues, and institutions you have been in contact with.

It is only through meeting these problems head on, seeing them for what they really are, that we will ever effect any meaningful change.

In my lifetime, I want to be a catalyst for change in my field. I want to shake some things up. I want to see us treat patients fairly, efficiently, effectively, and with compassion.

I am not satisfied with coasting along for the rest of my career thinking that the status quo is the best we can hope for.

I know that we can do better.