More Americans going through a mental health crisis are seeking care in hospital emergency rooms not always equipped to give the psychiatric care they need, a Newsy investigation has learned.
Breia Birch, 44, suffers from bipolar, post-traumatic stress and dissociative identity disorders.
She began thinking about suicide after her mother’s death in 2017.
"I remember sitting down at my table and getting my pills out," Birch said. "I started to separate out the ones that would hurt or hurt me out of the pile of pills. I was trying to kill myself."
She went to her local emergency room in Manhattan, Kansas, for help.
"Unfortunately, there aren't many places in Kansas where you can go and get screened. You have to go to the ER," Birch said.
Across the country, mental health-related ER visits shot up 66% from 2013 to 2018, according to a study published in the Western Journal of Emergency Medicine.
"Our rooms are full," said Robyn Chadwick, president of Ascension Via Christi St. Joseph hospital in Wichita, Kansas.
"Every single day in this facility, we have patients who are suicidal or homicidal," Chadwick said. "On a good day, there will be 10 behavioral health patients waiting in the emergency room. On a really bad day, there might be 30."
Nationally, bed capacity for psychiatric patients has plummeted in recent decades.
Care outside the hospital can also be hard to find. An audit from the Government Accountability Office this spring found mental health patients with insurance “experience challenges finding in-network providers.”
Patients also face a shortage of psychiatrists willing to accept Medicaid. Emergency rooms are also coping with a surge in behavioral health visits related to substance abuse.
"Substance abuse and mental health have always gone hand-in-hand," Chadwick said.
Patients with nowhere else to go are flooding emergency rooms.
"Whatever that mental illness is, if you can't get help, the situation gets worse, it escalates," Chadwick said. "The emergency room is the safety net for everything."
The problem is, hospital emergency rooms are struggling with the influx of patients who, like Birch, are desperate for help.
The ER closest to her in Manhattan, Kansas, was like many nationwide that don’t have a behavioral health unit.
"They couldn't find me anywhere to go for mental health," Birch said.
She was so desperate for care, she steered herself in a wheelchair toward traffic outside the ER so she could get into a state hospital.
"I did what I had to do to get help," Birch said.
A Newsy analysis of data from the Centers for Disease Control and Prevention found of all psychiatric patients who go to the ER, about 11% leave without a follow-up plan for care.
Eleven percent may not sound like much, but it equals hundreds of thousands of patients in mental distress leaving the ER without a referral for future treatment.
Chadwick says too many hospitals are not able to meet the need.
The hospital she leads in Wichita built a new space to expand behavioral health treatment.
"There are special screws used that cannot be pried out because a screw could then be used to harm yourself," Chadwick said.
To prevent suicide by hanging, doors have special handles. Televisions mounted to the wall don’t have exposed cords.
The build-out took money: about $60 million. It also took determination.
"It has become very personal," Chadwick said. "My oldest daughter, who's now 22, attempted suicide twice as a freshman in high school. And it really hit home. She's what drives me to make sure that everyone who needs care gets it."
Outside the hospital, leaders in Sedgwick County surrounding Wichita established a rapid response team to help with mental health-related 911 calls when people may not need the ER.
They also set aside $15 million for a new mental health community crisis center.
County Commissioner Lacey Cruse envisions an area between the hospital and jail could be used to help psychiatric patients before they need emergency help.
"What we need really is like sort of a one-stop shop," Cruse said. "Let's make sure they have transportation and get there. And then let's follow up with them. You can't teach someone to swim when they're in the middle of the ocean drowning."
The county has not settled on when or where to build the new center.
Medication and a caregiver are helping Birch’s mental health, four years after struggling for emergency room care.
"I have to keep reminding myself that I really don't have too much to complain about right now," Birch said. "I'm just doing a lot better now and I just hope I stay on this path."