TOPEKA — Emergency rooms across Kansas are seeing an increase in people with behavioral and mental health issues seeking care amid the pandemic, and the medical facilities lack necessary resources or staff dedicated to serving these patients.
Many of them are awaiting an open bed at Osawatomie State Hospital or Larned State Hospital, both inpatient psychiatric facilities operated by the Kansas Department for Aging and Disability Services.
When the pandemic began, Osawatomie State Hospital reduced capacity from 60 to 44 to allow staff and other residents to implement social distancing guidelines and to ensure separate housing to monitor COVID-19 symptoms in new admissions.
Larned State Hospital followed suit in May when beds were reduced from 90 to 72 to allow for single occupancy amid concerns the disease would spread quickly if a patient were to test positive.
In August, capacity was raised back to 60 beds at Osawatomie, but Larned remains at 72 beds. Some patients have found themselves housed in the emergency room for days at a time while hospital staff look for an open bed at an inpatient facility.
“Most mental health patients in western Kansas already get taken care of by ER staff,” said Jenny Niblock, chief clinical officer for Citizens Health in Colby, which has struggled with overflow since Larned reduced capacity. “These are family practice physicians that also need to take care of every other patient that might come into the ER, so there isn’t the staff to dedicate to sitting with these patients and taking care of them long-term.”
Since the pandemic began in March, hospitals across the state have reported higher numbers of patients seeking behavioral health treatment, as well as an increase in the severity of psychiatric cases. With reduced capacity at state hospitals, issues already present with mental health treatment have been exacerbated.
As of Sept. 14, an estimated 32.5% of Kansans are experiencing symptoms of an anxiety disorder or depressive disorder, according to a survey conducted by the National Center for Health Statistics.
The same survey shows 31.1% of Kansans did not get the care needed or had their care delayed amid the pandemic.
This delay in service, at least for Citizens Health, could be in part because many inpatient facilities require a COVID-19 test before they accept a patient, Niblock said. While Larned does not require a COVID-19 test, many inpatient facilities do.
However, Niblock said, rural hospitals like hers do not have access to rapid testing. As a result, the Colby-based medical center often must hold patients for 24 to 48 hours while they await the test result.
Even if the test comes back negative, finding a bed can be difficult for rural facilities like Citizens Health, where the nearest inpatient facility is a two-hour drive away and the nearest outpatient facility is three hours away.
“Rural mental health patients already have a huge disparity in access to mental health inpatient and outpatient services,” Niblock said. “If all beds are full, we may need to look as far as five hours away for the necessary care.”
The overflow of behavioral health patients camped in ERs is not limited to rural Kansas.
Lauren Lucht, executive director of behavioral and mental health for The University of Kansas Health System, said its Kansas City emergency department has seen an uptick in acute presentation of patients in need of psychiatric care.
Since the pandemic began, both their Marillac Campus and Strawberry Hill inpatient units have been full, Lucht said.
“COVID-19 has brought on an increase in stressors, anxiety, social isolation, depression and substance use,” Lucht said. “All of these things have contributed to an increase in patients presenting to our ED for admission to one of our inpatient facilities or for an emergency hold until a patient is accepted into a state hospital bed.”
Making things worse, community supports for mental health patients have dwindled during the pandemic, Lucht said. She said this has made post-discharge placement back into the community with adequate outpatient services more difficult than ever.
In response to the growing need for services and the shortfall of beds needed to accommodate patients, KU Health System has partnered with KDADS to discuss how to rectify the issues.
Cara Sloan-Ramos, spokeswoman for KDADS, said the department has adapted quickly to delays caused by reduced capacity. She added the need across Kansas communities for inpatient psychiatric treatment is on KDADS’ radar.
“KDADS continues to work to use the additional funds recommended by the governor and approved by the Legislature to add capacity at OSH, expand the use of regional diversion beds and eventually lift the moratorium on voluntary admissions at OSH,” Sloan-Ramos said.
Patients needing a bed at OSH often end up at Lawrence Memorial Hospital, said Derek Hurst, director of the integrated crisis team for Lawrence Memorial Hospital Health.
Since the pandemic began, Hurst has seen an increase in the length of stay and severity of cases for people waiting for a bed at OSH. Hurst’s focus is on preventative services.
The Lawrence hospital created an integrated crisis team to help reduce the utilization of state hospitals. Staff help connect patients with services before they require a stay at either state hospital, something Hurst said is necessary to mitigate the state’s mental health crisis.
“The state hospital system has been stressed for a long time and needs some revitalization, but also throwing a bunch of money at a hospital is not going to solve the problem,” Hurst said. “What helps solve that problem is prevention, and the way to do that is making sure you have robust programs and funding at mental health and behavioral health services in your community.”