Compassionate Care in the Emergency Room

By Colleen Duewel | Jun. 05, 2015
Emergency Department Survey Results
Results from NAMI's 2014 survey on Emergency Room (ER) visits for families and individuals who had a psychiatric emergency.

 

“The nurses and doctor I came into contact with were not sympathetic to my mental health crisis and did nothing to ease my anxiety or fears instead threatening me to do as I was told or I would be restrained.” – Emergency Room psychiatric patient.

The Agency for Healthcare Research and Quality reported that mental health and substance abuse cases accounted for 1 in 8 Emergency Room (ER) visits in the United States in 2010. However, ER nurses and doctors have less training in psychiatric emergencies than they do in broken legs and chest pain. In the ER an individual in distress often experiences a long wait time without mental health treatment. One person said, "[sitting in] the waiting area when you are in crisis is the most difficult part. Until you are taken back to a room, it can be very difficult to cope with all of the things happening [around you].”

In the fall of 2014, NAMI released a survey asking families and individuals who had a psychiatric emergency to share their experiences from the ER. With over 1,000 individuals responding, 2 out of 5 rated their experience as “Bad” or “Very Bad.” Regardless of things like race, household salary and education level, the survey showed the following four factors from staff treatment influenced a positive experience:

  • Staff communicated effectively and listened to my concerns
  • Staff treated me with respect
  • Staff did not make me feel ashamed as a result of my mental illness
  • Staff provided me with community education and support groups like NAMI

Of the 1,400 family members surveyed, the consensus was similar. They were concerned about staff communication, access to extra resources and wait times. One family member noted that staff should, “Keep [the family] in the loop. Assume they should be in the loop as you would assume a family would be involved with a broken leg. Unless [the] patient requests they not be involved, or red flags indicate otherwise, the family should [be involved] and hear [the] treatment plan etc. first hand.”

With individuals and families, perceived shaming of mental illness and low levels of respect were predictors of negative experiences. One person reported in the survey that, “I felt like I was criminal. There were guards around me that did not talk to me at all…I was made to feel as if I had done something wrong.” For the 22% of people who reported positive experiences, the staff’s ability to communicate and listen to individual concerns were important factors.

According the Emergency Nurses Association, the factors that lower the quality of health care in these situations include a lack of consistent guidelines and training.  Programs like “Friends in the Lobby” and “NAMI in the Lobby” in Minnesota and San Diego are pioneering the way in providing better post-ER resources. NAMI has jump-started efforts to educate staff at various hospitals.

Together with the Hospital Corporation of America, NAMI created a Competent Caring training video to show the impact that compassionate, patient-centered care on the patient experience. Additional tools for nurses and doctors include pocket cards with guidelines for patient-centered care, in-service training outlines and Emergency Psychiatric Care conference presentations.

NAMI continues to work at improving the experience of people who go through a mental health emergency. Ultimately, the goal is for everyone having a crisis to have the experience of  staff inclusion with questions, compassionate treatment, with a balance between handling the emergency and catering to caregivers. 

Comments
Kevin Barone
I have been trying to get a sphych eval done on myself and hate hospitals...I have been for drug and mental reasons and other reasons....never or just mental...I just want a diagnosis and can't get one it takes too long it will just been too late can anybody help me please ..I'm suffering and cannot begin to explain how.im outcasted everywhere I go people treating me like. A normal person that just an ***** or has issue or something and nobody cares that I have actual issues that get in the way of work...I have been searching for some advocate for three years with no success and I live in South East Massachusetts ..supposedly good health care I don't know what to do cuz I can't tell the drs il suicidal or they will force me impatient so how Al I supposed o be diagnosed without being punished?? Helpone month and it's too late
8/24/2018 4:16:59 PM

Thom
Was looking for info on mental health care in the ER and I god my answer. Don't go to the ER for mental health care because they will treat you like crap. I've been trying to find competent mental health care for 54 years with no success. Psychiatry is a con.
3/21/2018 6:54:54 PM

candace
Every time I visited hospital i was asked first did you take yo ur no polar medicine. Then doctor said now what's wrong. You don't have no swelling there. Just as nasty to me and I left ashamed and humiliated. Then they write things hidden about what a mental case they think for the next rude nurse and dr. So they act even worse. I cannot believe how I have been treated. And I'm very sick so they stick me in blue suit and admit me to mental ward for 8 days just because I'm bipolar. If it's the last thing i do on earth it will be to change this kind of terrible treatment.
3/14/2017 12:57:51 AM

Will Nist
I will never again ask for help from anyone for my depression. Especially in an Emergency Room. I will walk in. Then wait for the Dr. to come in. Then I will take out my razor sharp ( I was an Eagle Scout - I sharpen mine very well ) and cut very deeply into my throat. So deep even in the hospital there will be nothing they can do. We all know when they see blood they actually do something. There will be a note in my pocket thanking then for being so kind and helpful in the past and hoping they never get depressed themselves. It wll also state that not all of the depressed are morons. Which for some reason still unknown to me seems to be what Dr's and nurses think of those withe depression. Aslo, we don't feel any physical pain. Being on my record (depression) when I had two consecutive knee surgery's I was given close to zero pain medication as the mentally ill according to the RN claimed we don't feel pain like real people. I suspect she took them herself. Who would believe my complaints. No one did. Especially the police and security after she called them following my complaint. I longer consider myself an American and as well hate everything the United States stands for and would do anything to cause it destruction. If US law allows this (it does as there is no real way to stop it), then I no longer consider myself one and feel no obligation to follow it's rules. If it doesn't protect me and defend me I will do what I can to destroy it and hopefully find people who do. Thank you. I am not suicidal or homicidal here for legal reasons. I wish to make that quite clear to those who would wish to use my words against me. F dirty Dr's., nurses police and all others who wish to treat me worse then an animal. I wish the same and worse on you and your family's. I hope your young defenseless children suffer the largest amount of pain a human being can endure. Then brought back and have it done over and over again infinitely. While you must watch. Enjoy your lives, you special people who enjoy life pain free. Physically and mentally. Until it's your turn and may you be "helped" by those like me. The same who you have "helped". May those you love most suffer and burn forever in hell and pain. Merry Christmas to our "first responders". Keep congradulating youselves. I KNOW WHAT YOU ARE REALLY LIKE. WILL
12/9/2016 2:30:04 AM

LACHAUN DENSON
There it is Catherine Errico said it out her mouth the ER dont give a care she the perfect example of enedequet training.. She said mental health pt waste time coming in all the time ... Duh stupid they sick i pray your child never ends up mentally ill
11/23/2015 12:51:18 PM

Jackie
I've been mistreated by both Casper Police and Wyoming Medical Center. They put you in a room with a prison bed on the floor. I asked the nurse why was I laying on a floor and she said "there arent any other beds". This is after a rookie officer cuffs you and decides you are suicidal. How they make that call is beyond me. Its awful and scary. Many people resist help all because it is too difficult to get proper care when you're being treated differently than other patients. Makes me sick.
7/31/2015 12:32:55 AM

Tamara Clark
Without better education as to what is possible in Recovery of Mental Health illness . We will never see more compassion in our ER's. NAMI's in your own voice program should be mandatory for all ER staff.
6/29/2015 4:05:07 PM

Barbara Stackhouse
My son has mental illness a he rejects the fact he needs medication, therefore we have had to 302 him, He now lives in his own apt, which makes it even more difficult to get him help, June of this year, we got a complaint from the apt mgr that he was saying inappropriate things to others in the complex, My son has good rapour with the local police an they were able to talk him into going to the ER for help. The police chief told me that the Dr in the ER was condescending an abusive to him an that my son walked out of the ER refusing help an the Chief said he didn't blame him. Now we have a bigger problem as his condition was deteriorating, it took another 3 weeks before the police were able to talk him into getting help. This time they took him to another hospital and he signed himself in. He was there for four days an decided to walk again. Two weeks later the police were able to talk him into going in, this time the Dr had the intestinal fortitude to 303 him. After the episode in the E

My son is mentally Ill an in denial, so it is very difficult to get him help. After 302ing him numerous times to no avail, we went to the police an fortunately they were familiar with him an his mental Illness, an had, in the past asked him if he needed a ride to the ER. In June once again he needed to go into the ER for evaluation an was refusing, after two weeks the police were able to get him to go to the ER. When in ER the Dr on his case wasn't someone who knew how to handle ML patients as he was condecending and rude according to the police, an he walked out ,the police took him home. I was furious as we had gone to great lengths to get him help an then for the ER Dr to agitate him to the point he would walk out was frustrating. I called the ER supervisor an filed a complaint. Two weeks later when we were able to get him back into the ER, that Dr was no longer employed there. The problem he caused is still reverberating as he is now in the hospital an very delusional, His hospitalization was extended just because of the experience he had in the ER. The police are very cooperative an helpful, now when my son needs help I contact them an they call me when they have him on the way to the hospital an I call the ER an inform them that he is on the way an he needs evaluation for mental Illness an they are to call me a let me know if he is going to be hospitalized, before they release him. I always ask for the supervisor on duty.

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6/29/2015 10:58:43 AM

Caroline Ehrlich
A number of years ago, I had on many occasions had to have the police take my son to the ER in California. Having been a NAMI member, I immediately drove to the ER and when I arrived, I had my son's mental health history with me so that the ER doctor could look at it before seeing my son. It was very helpful to the ER doctor and on one occasion I was complimented on it by one of the doctors who said that he wished other parents would have a written mental health statement with them including their history, diagnosis and medications. NAMI was instrumental in my having this document with me when going to the ER.
6/25/2015 4:42:29 PM

Belinda Harris
It also needs to be shared with the Security Guards/law enforcement officers who know nothing about professionalism when it comes to treating Mental Health patients or their families. I have encountered some who do not need to be working with Mental Health patients. They have absolutely no understanding of the concept of Mental Illness at all! They are under the sad misconception that the patient can control their behavior, so they treat them like dirt! They should hope that one of their loved ones does not have to experience what they have subjected some of the patients that they have restrained and abused to. And I'm not speaking of all of the people in this profession, but just like with any profession, the guilty ones know who you are.
6/25/2015 3:38:38 PM

Ken Lewis
Wouldn't it be so great to have our trained peers with lived experience available in ER for us when we need them. To me this is the answer and of course family, and continued education to all staff that work in the ER's.
6/25/2015 10:57:11 AM

Margaret
As a soon to be graduating nurse planning to work in psych, I have had rotations in the ED that were less than mental health friendly, as they yelled across the room "such and such is back" with only one room available for psychiatric patients. My sister also has borderline personality disorder and time and time again we have been in the ED waiting, stuck with nurses and physicians ignoring us because of the stigma. After she popped an unknown drug they ignored our cries for help as we knew she was going to something lethal, as it was only a matter of time. We waited forever to be seen and let go. Before we knew it she had taken something lethal to end her life and ended up in the ICU for days. I think that in my experience working in the ED and watching it from a family member perspective it is just awful. It seems to me like not only does the care team does not have the time or patience for these patients because there are, "more critical" patients. Someone loosing their life is a big deal whether from a heart attack or suicide. These patients need advocates and as a nurse I want to be an advocate for them. I don't know if patients with mental illness should have their own ED or the care team should have better training, but the initial ED visit for patients establishes whether or not these patients will trust the doctors and nurses throughout their hospital stay (if they go to an inpatient ward) and this time is critical.
6/24/2015 10:15:23 PM

Cheryl Winfield
I was taken to an ER because of a letter I sent out contemplating the idea of suicide & very low blood sugar & blood pressure. The ER physician treated me like I'm a criminal, was talking to me very loudly, and there was no patient-doctor confidentiality when an aide, the ER dr., a nurse, and my mother demanded that I explain why I felt the way I did & saying the letter is very decisive. What I couldn't say is that my mother thought it was a good idea to no longer financially support me; therefore she thought it would force me to work on Sundays & take any job that pays. What it did do was cause my depression to return harder than before & starved me. A short time after the little meeting my bloodwork came back, and I was fine then (in a far better attitude ) he then did an ER tests (squeeze his hands, follow the light with your eyes, etc.) then said i'm fine. I wanted a priest, but they were trying to put me somewhere. Before I was taken to a BHER (Behavioral Health ER), my mother told me I love you & don't tell them you are on the title of the house. When I got there I was the only female patient, and there were 5 men in an open room-2-bed cubicle, the beds were separated by a drape, and i had a male roommate. The bathroom didn't lock, so any one of the male patients could go in, the guards were loud, the are itself was very warm to hot, I was sweaty, whatever sleep I could get I was woken up every two hours to have my temperature & blood pressure taken. In the morning, I was met by the pscyc prep & an ER dr.. The rep treated & yelled at me that wanted to know if I will take my own life & what led me to that place. I honestly felt that I would never see the light of day again & if I would go to jail or somewhere worse. I agreed to go to an outpatient facility (that treated me far better), and was given discharge papers after I told the psyc dr. that I wouldn't take my own life, and I told him no that I wanted the pain to stop. I told my mom what to bring me to wear (sweatpants & tank top & I will walk out in the socks that I was given) & was surprised that I didn't want to look more normal leaving a hospital. My mother still is my problem mentally & sometimes physically, especially when she wants me to have my sister & her side of the family (my mother's,that is) like it's my place for me to suffer & be submissive to them-that I'm not an adult unless I meet the qualifications to be an adult to them or be exactly whom they want me to be;rather that be whom I am whether they like it or not.
The say people can't cause depression, but they certainty bring it about, so can ERs & their staff.
6/24/2015 9:38:18 PM

Deborah Pickering
I understand what everyone is saying .Been there too, It is no help just being put on a stretcher not a bed. Everything going on around you. Nobody sits down to talk to you. No medicine given even when you had your med list. So the noice and all does more to send you over the edge ! They are right everybody doesn't have the time for you. Makes you want to not go in for help. Just end it already in your own house. Same when they transfer you, they take a day sometimes before any meds are given too.
6/24/2015 8:53:08 PM

Ingrid
4/15 I recently went to Princeton Hospital in NJ. I went to the desk to tell the receptionist I was feeling suicidal and had a plan in order. She rolled her eyes!!! Can you believe that? The first 5 hours they didn't let my husband in the back with me...I sat alone and was being watched by a camera...It would have been nice if my husband was there with me....no? My husband called there and was really mad. He left out the part about the eye rolling which had me so pissed after the fact. I have to say that mad me more embarrassed that she rolled her eyes. I'm ashamed as it is.

Thanks Princeton Hospital in NJ Yes...I'm just 1 review and I felt ashamed and embarrassed.
6/24/2015 8:27:48 PM

Russell Stubbs
I have been to the emergency room once for mental health reaasons. It was neather bad nor good. They gave me meds and sent me home.
6/24/2015 8:12:09 PM

Catherine Errico
I am an Er nurse in a very busy hospital and although I agree that people in crisis do not always get treated fairly, the ER staff is not always to blame. I have been spit on, punched, kicked, had my hair pulled, been called every name in the book all while I was trying to care for a patient. Most patients who are out of control must be restrained for their safety as well as staffs. Restraining someone is labor intensive and not something we are encouraged to do. I will agree the long waits are terrible. But in a busy ER everyone except for the most critical patients must wait. I have seen security go over board with patients and have spoken to these people myself about the excessive force. I am told "fine you protect yourself". There are always two sides to every story, I have had patient yell at me for talking about them when I was doing no such thing. So it is a difficult situation for everyone. People with a mental illness diagnosis need help so it does not escalate to an Er visit. We have repeat patients that we see a few times a week and they are screened and sent back to their homes. This takes up valuable time and resources. Why is no one receiving care outside of the hospital setting? This is where the problem starts. If only a few patients that come into PIP get admitted then it seems someone should be helping these patients before they decide they need to come into the ER.
6/21/2015 5:32:05 PM

Lisa seek
The ER treated my son like an animal. Would not allow him to to do a drud urine screen naturally The forcefully inserted a catheter to extract urine as he lay there restrained and others walking by watching him as this horrible act took place. He has post traumatic stress because of this awful treatment. He is only 21.
6/21/2015 11:00:09 AM

Dodie Melvin
Are the Pocket Cards and other tools available for purchase? I would like to see a copy of the survey questions, as well.
6/18/2015 1:35:30 PM

Barbara Holloway
My last experience waitinfg in the ER was horrible. The people who came in after a bar brawl and still fighting ate up all precious time the. ER, staff had. I felt threaten & vulnerable, Very much alone. I have bipolar depression & had I left the ER I probably would of end my suffering.
6/15/2015 8:38:26 AM

Brenda T
I just experienced an absolute horror story in the local ER. 5 days of solitary confinement - no clothing, no window, no sunshine, almost no visitors, nothing to do, no control of my own of any kind, and very unsympathetic and unkind staff. I do live in a state (Wyoming) which NAMI graded as "failed" on Mental Health. This needs to be addressed and quickly.
6/13/2015 12:55:26 AM

Michele White
I was taken to the ER via Ambulance after a suicide attempt (overdose and wrist cutting). The doctor was furious with me and went out of his way to hurt me during examination, the nurses ignored me and when I asked for bandages to go over my cut up wrists, I was give just that, a bandaid. My insurance refused to pay for the ambulance ride or the ER visit - they only covered the inpatient care because there was no way out (no loop hole to avoid it) The insurance rep told me it was based on the fact that they would not cover injuries obtained while breaking the law. When I said I had not broken the law - I got a lecture that I committed a crime against god and man!! They never did pay the bill and I was just too tired to fight them
6/12/2015 7:29:26 PM

Rachel
I firmly believe that the emergency rooms don't treat Patients good at all. We do need one or more people to be available to such as a NAMI advocate, peer advocate or a social worker.For many individuals they have no family and they are alone. Also many families don't want to be involved with the person with our illnesses. The stigma is highly prevalent for the people with psychiatric problems whatever it may include. We all should get good care. Where I live one hospital sends psychiatric patients to another hospital in the same area. That is not right. NAMI needs to address this issue to hospitals, ambulance, and police. All emergency service organizations. I would like to help in this urgent need, HOW CAN I HELP in this cause?.
6/10/2015 10:35:25 AM

Teri
Glad to hear it's at least something AHRQ is addressing. I think, bottom line, there's still too much stigma & judgment from heathcare providers, even if they have the best intentions. Someone comes in with anxiety, they're a hypochondriac. Someone is suicidal, they must have a personality disorder. If a physical reason for medical symptoms isn't found, it must be psychological in nature. What happened to objective, non-biased holistic assessment of a patient? Unless someone is an immediate threat, give them a chance!
6/6/2015 1:43:27 AM

Kathleen Brannon
And can you provide a contact for the "Friends in the Lobby" and "NAMI in the Lobby" programs? I would like to volunteer for one, or help start one if there is no program locally. (I live in the DC area.)
6/6/2015 12:46:14 AM

Kathleen Brannon
I am SO glad people are finally paying attention to this issue. So many people who go to an ER for a mental health crisis are so traumatized by the experience that it makes their state of mind worse, makes them avoid ever going again and sometimes they require treatment for the "treatment" they received! This is also true of some inpatient psychiatric programs. Way back when, "community mental health centers" offered emergency mental health services, not hospital ERs. That is so much more sensible and humane. At the very least a mental health crisis counselor, advisor, peer, etc. should be on duty in every ER all the time.And thank you NAMI for talking about this issue and for the programs you've started to help people who've come through the ER experience.
6/6/2015 12:43:10 AM

Carol
The mind IS connected to the body...
6/5/2015 11:25:34 PM

john c. edwards
live it
6/5/2015 10:38:05 PM

Marianne
as a person who self mutilates and in the er frequently for care, a lot of the Drs and nurses do not show compassion and do not even try to understand what is going on. I must say my last hospital stay in November couldn't have been more amazing which shocked me. The dr who stitched me had a great sense of humor and it was more care I received from the dr more than the nurse. I definetly returned a good survey for that stay for its unusual to have such great experiences.
6/5/2015 9:21:35 PM

Michelle Corbin
Treat us like humans!! Oh and remember we don't have the plague so you can't catch it!! I have a brain disorder what's your excuse?
6/5/2015 8:38:12 PM

Rubin Latz
I regret that I cannot preview the DVD without ordering. Please advise: is this an open-captioned product? I surely hope it is. IF not, I cannot in good faith promote it to friends and family.

Thank you.
6/5/2015 8:30:09 PM

Susan Gough
I am looking for the resources mentioned in the article as I am trying to work with the ER's in our area to improve care for people with mental illness and substance abuse. Could you please tell me where to get the pocket cards, in-service training outlines and conference information? Thank You.
6/5/2015 7:50:04 PM