National Nurses United

RoseAnn DeMoro Executive Director, National Nurses United Mental Breakdown Our mental healthcare system has collapsed in favor of pursuing profits. I f there���s one symbol of the breakdown of our healthcare system, it might well be the growing disappearance of mental health services���with severe and sometimes tragic consequences for patients, nurses, and our communities. With corporate hospitals shredding patient services deemed less profitable and underfunded state and county hospitals making cuts to survive, psychiatric care is often first on the chopping block. Increasingly, if those patients get into the hospital at all now, they end up in the emergency room or other units that are unprepared to provide the specialty care they need. Just ask a nurse���like Jane Sandoval, an ER RN at Sutter Health���s St. Luke���s Hospital in San Francisco, which long ago eliminated psychiatric services. ���The driving factors are that mental health is not a moneymaker for the giant healthcare corporations and the perception of mental illness as a��stigma.��� Without specialized care in the lowincome neighborhoods around her hospital, says Sandoval, ���the patient would languish in a hospital emergency room hallway until placement could be established or their psychiatric hold was exhausted. This meant they were released from their holds, if appropriate, and out to the public, only to meander to another ED. ���Some psychiatric patients are gravely ill.��Others simply do not have the mechanism or wherewithall to access services.�� Psychiatric patients need psychiatric care. An emergency department is hardly a therapeutic milieu.��What they receive is a gurney, sometimes in the��department corridor for up to 72 hours, and��security personnel to watch over them, not a��trained psychiatric clinician. ���Nurses in the department,��with patient loads up to four patients at a time in the ED,��may not always be able to give optimal psychiatric care.��With several psychiatric patients in the emergency department, there is a potential for J U LY | A U G U S T 2 0 1 2 escalation of their behaviors. This jeopardizes the safety of staff and nurses and visitors in the department.��� The result: rising incidents of violence against nurses, other hospital employees, and other patients, with far too many hospitals lax in providing appropriate safety protocols for staff and patients alike. With private hospitals increasingly abandoning mental healthcare, the onus again falls on public safety net institutions, where the crisis is growing daily. Here���s how it looks to Stu Berger, RN at a public facility in San Mateo, Calif. ���In recent years, many of the county mental health clinics have seen increasing numbers of people entering our system. There are many reasons for this, partly because of the emphasis on destigmatizing mental health issues and, more recently, loss of employment (along with health benefits) stemming from the economic downturn. ���At the clinic in which I work, our enrollment has soared to well over 1,000 clients and continues to rise.��However, we have the same number of staff and a vacant��half-time MD position remains unfilled due to, apparently, budgetary concerns. ���There also seem to be more people who��are homeless, but the resources in the community, including homeless shelters, remain inadequate. We have the knowledge and skill to effectively treat our clients, but with the administrative emphasis seeming to be on numbers versus resources, our hands remain largely tied in helping to keep clients in the community, off of the streets, out of jail, or out of the hospital.��� �� This cycle begins with the mentality of those corporate hospital systems that act more like Wall Street hedge funds than like institutions whose mission should be therapeutic healing. A just-released report from our research arm, the Institute for Health and SocioEconomic Policy, on California private nonprofit hospitals report found that many, W W W. N A T I O N A L N U R S E S U N I T E D . O R G especially the biggest chains like Sutter and Kaiser Permanente, are cutting services, with mental health on the top of the list, while piling up huge excesses in tax benefits and profits over what they provide in charity care. Three of the six most egregious hospitals in accumulation of tax benefits over provision of charity care���Sutter���s California Pacific Medical Center in San Francisco (of which St. Luke���s is a part), Sutter���s Alta Bates campus in Berkeley, and Cedars-Sinai in Los Angeles���have been especially aggressive in cutting back on mental health. Between 2004 and 2008, CPMC eliminated 45 percent of its psychiatric beds. Alta Bates��� ancillary Herrick Hospital, which specializes in psych services, which had 34 adolescent psych beds until 2007, now rarely cares for more than eight patients, and beds for dual diagnosis patients have been cut in half. Cedars-Sinai, whose behavior regularly contrasts with its inflated hospital-for-the stars image, announced last December plans to cut its entire inpatient and psychiatry programs, leaving its patients out in the cold. ���The patients who need psychiatric services are stacking up at the door and having a hard time getting in. It���s getting tough out there,��� Randall Hagar, director of government affairs for the California Psychiatric Association, recently told the Los Angeles Times. In California, state hospitals have seen a 16 percent drop in patients the past five years as a result of cuts. Nationally, the number of state hospital psychiatric beds dropped by 14 percent between 2005 and 2010, the Los Angeles Times reported in July, with many severely mentally ill patients ending up in emergency rooms, jails, and prisons. In Massachusetts, between 2008 and 2011, the state cut more than 25 percent of public-sector psychiatric beds, decreasing (Continued on page 23) N AT I O N A L N U R S E 13

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