A Watched ED Never Boils.

I may be bad luck. I’m back in the Emergency Department of the Brigham and Women’s Hospital to report on psych patients, but there are none.

No typical ones anyway. There is one suicidal patient with acute depression waiting to be transferred to an in-patient facility. But, as Nurse Nina Ribeiro, 24, says “this is not your typical psych patient.”

Rather than aggressive and argumentative, this patient is quiet and gentle, sleeping in her darkened room while her “sitter” — a designated nurse’s assistant who literally babysits psych patients — does her homework at a desk outside of her room.

“That’s an element of her depression. She’s accepting, she needs compassion,” explains the dark-eyed and upbeat Ribeiro.

But its not just the patient’s docility that makes her atypical — she’s spends only a few hours in the hospital before being transferred to a psychiatric facility. Ribeiro estimates that typical psych patients wait for 12-24 hours before being another facility is found.

How did this patient luck out? Boston Emergency Services Team, or BEST.

BEST sends clinically trained psychologists to assess psychiatric patients and find programs for them. Tonight, the atypical patient was placed in a psych facility by BEST psychologist Gary Joslow, 66, who spends 40 minutes to an hour assessing a patient before recommending a program and finding a place. He finds they don’t always need the in-patient care the doctors recommend, so he looks at a larger pool of resources when placing a patient.

The depressed patient was lucky to have Joslow find her a place so quickly, but she was a bit sad anyway — she didn’t want to leave Ribeiro behind. The two hugged in the hallway before the EMTs wheeled the patient out, and docile or not, it’s best for everyone when psych patients are in facilities with the resources to take care of them.

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6 thoughts on “A Watched ED Never Boils.

  1. Sounds like a great program! That’s wonderful that he was able to find her a place so quickly. I’m amazed that their average time before placement is just 12-24 hrs. I spent a night observing a psych ED here in Connecticut, which was full and overflowing (but they still couldn’t turn anyone away) and placing patients seemed incredibly difficult because there was just no space. There was also basically no hope for patients without insurance. The nurse practitioner I worked with said they had had patients spend weeks in the ED because none of the psych floors will take patients without insurance – atrocious. I really hope that mental health services will soon get the attention and funding that’s needed.

    • Sometimes ‘placement’ just means being admitted to another floor of the BWH, which doesn’t have a dedicated psych ward.

      It’s true though that the Brigham is quick and fairly capable compared to a lot of hospitals dealing with psych patients–but that’s because it’s a well-funded, well-respected Harvard-affiliated teaching hospital in the middle of an urban medical mecca.

      The Brigham is not your ‘typical’ hospital, and still their staff feel overwhelmed and under-resourced when it comes to caring for psych patients.

      If the Brigham is struggling, it means the problem is likely much worse elsewhere.

      Thank you for commenting!

  2. It would be interesting to know if this patient is a repeat patient. Putting her on a program is positive, but how successful are these programs – ie. are these programs revolving doors? Do any of these programs “solve” the problem, or are they just a quick fix that leads to a repeat 6 to 18 moths down the road? Just wondering??

    • there are many, many repeat offenders though I’m not sure of the percent that we see here at the Brigham.
      I can’t speak for the lady last night but….

    • Hi Andrew,

      The woman I wrote about had attempted suicide previously, so you could call her a “repeat patient.” I don’t think that means psychiatric treatment programs are not successful. Mental illness and addiction are more like chronic diseases than problems that can be “solved.”

      In many cases patients need to be put in an in-patient facility not just to be treated, but to be monitored. Suicidal patients are “sectioned,” or detained against their will under Section 12 of the Massachusetts laws governing mental illness, and cannot be released until a psychiatrist decides they are no longer a threat to themselves or others. Sometimes the threat passes after a few hours in the emergency room, but often patients need several days of care before they are stable enough to be released.

      Thank you for commenting!

  3. Pingback: A Watched ED Never Boils. | HealthcareLiterate

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