“There’s one psychiatrist in every five counties we serve, so you can see there’s a lack of opportunity,” Scoggin said.
Without preventive care, people facing mental health crises in rural counties like Titus end up in the ER. Some are brought there after public disturbances. Some were brought in by relatives.
Patients who enter the ER may spend days or even weeks waiting to be evaluated by local mental health officials before being discharged or transferred. For patients at Titus Hospital, which doesn’t have a psychiatrist on staff, it’s the Mount Pleasant Mental Health Clinic, which serves four counties but is struggling to keep testing patients.
In Titus, patients with mental health needs are typically taken to Terrell State Hospital, where wait times are also long.
“Terrell remains full. That’s what it is. It’s not us, it’s Terrell,” said Rachel Sills, director of the Mount Pleasant Mental Health Clinic. Sills said her team calls Terrell daily when transporting patients, and she sometimes waits as long as 14 days for an opening.
Kathy Griffith is vice president of clinical operations and chief nursing officer at Titus Regional Medical Center. She worries not only about patients with mental illness, but also about the staff who sometimes deal with violent patients during long ER stays.
Brittany Bakaku, a licensed clinical social worker, said the isolation mental health patients experience while waiting in the ER can worsen symptoms and lead to violence against staff.
“When you put a client in a room and they have to stay in that room and they can’t leave the room for days on end, people get excited, right?” says Bakaku, an instructor at the school. He earned his doctorate in social work from Texas State University and, prior to teaching, spent eight years working in Texas emergency rooms in both rural and urban hospitals in Bastrop, San Marcos, and Austin.
Telemedicine in the ER could reduce violence and provide more timely care for patients
Concerned about the long wait times experienced by mental health patients in local ERs and the associated danger to staff; Griffiths collaborated with colleagues Baylor University Medical Center and St. Luke’s Health in Lake Jackson are exploring the use of telemedicine to help ER doctors treat mental health patients who end up in their departments.
A year later, the state Legislature appropriated $7.4 million over two years to fund telepsychiatry services for local hospitals, based on Griffith et al.’s research.
The pilot program began in March in Titus and Knox counties. Texas Tech University psychiatrists contracted with the Texas Department of Health and Human Services are available to local hospitals 7 days a week, 10 hours a day, and ER physicians treat mental health patients in the ER within the first 24 hours. can be started.
“Now you can at least get a diagnosis and a prescription and maybe even be discharged into the community instead of being discharged to another hospital,” Scoggin said.
Sills, of the Mount Pleasant Mental Health Clinic, welcomes the program because it reduces workload and helps move patients to more appropriate care settings in less time.
“This is a very high-risk, high-volume clinic, so local psychiatrists (via telemedicine) and paramedics will probably be able to move some people faster, whatever that means. I think it’s really helpful to advise them on whether it’s letting them go, getting them somewhere else, or allowing them to get treatment,” Sills said.
Griffiths hopes to demonstrate the program’s effectiveness and secure future funding, but the challenges of providing mental health care in rural areas extend beyond the ER. A shortage of health care providers makes it difficult to access ongoing mental health care in rural areas, even for those with private health insurance.
“I think we need to look at our community mental health infrastructure,” Scoggins said.
Tracking URL: https://www.texastribune.org/2024/05/07/texas-mental-health-hospitals-er/
