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Mental hygiene hearings flooding hospitals

CHARLESTON, W.Va. -- In West Virginia, mental hygiene hearings aren't just taking place in jails and county courthouses. They're also being held in hospital emergency rooms."Many of the folks being considered for involuntary commitment are taken unnecessarily to hospitals, even during business hours when the courthouse is open, contributing to overcrowding and delays in already overtaxed emergency departments," Charleston Area Medical Center lawyer Dina Mohler told state lawmakers Monday.Since June, 121 mental hygiene applications were filed at CAMC General Hospital's emergency room, Mohler said. The numbers exclude drug overdose and suicide patients.Some involuntary commitment patients arrived at night after courthouses closed, but many others were brought in during regular business hours, Mohler said.CAMC was forced to host 50 involuntary commitment hearings in the emergency room from June 1 to Aug. 31."We're happy to take all the injured and sick, but people solely there for mental hygiene [cases] do not belong in the emergency room," said Mohler, CAMC's associate general counsel, during Monday's House-Senate judiciary committee meeting.Federal law requires hospitals to provide treatment to anyone who shows up at emergency rooms. The hospital must determine whether the patient has an emergency medical condition."The patient will receive much more than a behavioral medicine screening to determine whether he should be involuntarily committed," Mohler said. Since June, only three patients who came to CAMC General for involuntary commitment have had a physical illness that required treatment and stabilization."In a few cases, the patient actually has a medical condition that needs treatment," Mohler said. "But often this medical condition only serves to slow down the mental hygiene process and contribute to the patient's length of stay in the emergency department setting."Mental hygiene patients wound up staying in CAMC General Hospital's emergency room for 16.6 hours on average during their involuntary commitment hearings in July. The average stay lasted 12 hours last month.Thomas Memorial Hospital in South Charleston and Cabell-Huntington Hospital are struggling with the same problem, according to a report that Mohler presented Monday to state lawmakers.Thomas Hospital held 19 mental hygiene hearings in its emergency room from June 1 through Aug. 31.
Mohler suggested that the state establish separate sites where mental hygiene patients could go for medical screenings. She said involuntary commitment patients should receive screenings at behavioral health centers -- not at hospital emergency departments.
"It would be great if there was a place people could go 24-7 that was dedicated to mental hygiene," Mohler said.Also Monday, Karen Yost, CEO of Huntington-based Prestera Mental Health Services, told lawmakers that the behavior health provider is working with hospitals to alleviate emergency room overcrowding.Prestera has provided training to emergency room personnel, Yost said. The Huntington nonprofit also has worked closely with "frequent fliers" -- mental health patients who make frequent trips to the emergency department. Prestera also plans to open a "therapeutic living room" -- a place where mental health patients can go at night."The emergency rooms truly get hammered by behavioral health patients," Yost said. "It ties up the emergency room staff and their resources."Linda Pauley, chairwoman of the West Virginia Mental Health Planning Council, told committee members that the state must do more to help people before they reach "crisis stage.""Meet them where they are and treat them where they are," Pauley said.
The House-Senate committee started a study of West Virginia's involuntary commitment system last spring, after state Supreme Court Chief Justice Menis Ketchum told lawmakers that the state could save $3 million a year if it changed its mental hygiene procedures.Ketchum noted that the state was paying private lawyers $1.2 million a year to work as "mental hygiene commissioners." The courts also were spending money to hire special prosecutors to handle involuntary commitment cases.More than 7,000 mental hygiene cases were filed in West Virginia last year, but people were committed to mental institutions in only about half of those cases.Reach Eric Eyre at or 304-348-4869.    
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