I’ve been admitted to the psychiatric unit 32 times which equals to waiting in the emergency room for around 256 hours. Obviously, each admission differs but on average I would wait around 8 hours. Throughout the past nine years, I’ve learned the multiple different waiting rooms the hospital system actually has including triage, private rooms, the emergency unit, ICU, and even random rooms when there is no more space where mental health patients have to sleep in chairs. Canada has free healthcare, but is it worth it when thousands of people die due to malpractice in emergency rooms every year?
The emergency room has a five-level triage status for patients to determine who needs help the fastest known as the Emergency Severity Index (ESI). Figure I shows a diagram of the questions asked to determine the patients level. The levels start with the highest necessity of letter A and move down to the necessity of letter D. The AVPU table is then utilized for the patient’s consciousness:
A – Alert
V – Verbal
P – Painful
U – Unresponsive
The problem with the ESI process is that out of all of Level 1 indicators only two mental health related. A major problem with the screening of mental health in crisis situations is the history of the patient. A first-time patient is often easily pushed aside but someone with violence in their history is taken more seriously. The scariest part is those who have never attempted suicide or are not currently threatening suicide are often sent home. People in mental health crisis are not taken as life-threatening therefore they are put aside leaving patients waiting for hours, and these patients are forced to wait and often get worse with each passing minute until it develops into a life-threatening situation.
Example: My sister, Riley, brought me to the hospital on a Saturday night around 8pm. I was verbally unresponsive meaning my body had become so distressed I couldn’t speak or walk on my own. Several hours went by and I was only seen by the triage nurse. At this point I was extremely stressed and watching people who had come in after me see the doctor before me. On the sixth hour of waiting I stood up in the middle of the emergency room swore at the nurses and stormed out. Several minutes later I was found running from security bare-foot in the middle of the hospital, screaming at the top of my lungs and crying. After I had been taken down by security I saw the doctor. The worst part of this entire situation was the fact that security had come to help me only because I had a history of violence on my record and they knew me personally.
Stigma and Diagnoses
No Diagnoses – Sadly, even if you do suffer from a mental illness but it is not yet diagnosed prior to the emergency room visit you will be taken much less seriously. Often triage nurses forget the patient and just look at the file.
General Anxiety People often have an anxiety attack and believe it to be physical in which after hours of waiting they find out is a mental response to a threat or fear. If someone is diagnosed with general anxiety visits the emergency room there is an obstacle in front of them without them even knowing. This stigma prevents doctors and nurses from believing that an anxiety patient even needs help.
Addiction Addiction is probably one of the most stigmatized mental illnesses that the emergency room comes by. People with addiction are often categorized as criminals and told to leave or call a rehab centre. People with addiction often freeze in the streets, drink themselves unconscious, have heart and psychotic attacks, endure brain damage, and sometimes even die because of the nature of their illness, but due to the constant stigmatization towards addicts “not wanting” to get better, addiction being “a choice” or addicts being “criminals” stops the nurses from taking any addict seriously. They often ask addicts to leave for “the other patient’s wellbeing” depending on the drug being used.
Example: A man I personally know was told to leave the premises because he was “interfering with the peace” of the emergency room and “scaring the kids.” Several days later he was picked up from a holding cell due to public intoxication.
Borderline Personality Disorder People who suffer from Borderline Personality Disorder make up 80% of the people admitted to the psychiatric unit. BPD is characterized by extremely dangerous symptoms such as suicidal ideation, eating disorders, addiction, self-harm, and intrusive thoughts. These obviously need treatment ASAP and often lead to the patient’s death. The health system sees BPD patients as manipulative and refuses to admit them to any unit, sometimes they even go as far as asking them to go home. 10% of people with BPD will die from complications from their illness.
Example: I was told by the on-call emergency psychiatrist to go home because I was manipulating my family for attention when I had suicidal thoughts but no actions yet. Several hours later they found me unconscious in a parking garage.
# of emergancy department visits per Year
Unjust Atmosphere for Mental Health Patients
Mental health patients who are waiting for a bed on the psychiatric unit are often isolated from the rest of the patients awaiting beds. More times than not mental health patients have to wait between 3-5 days to get a bed on the unit due to overflowing admissions. The patients are forced to wait in the emergency unit, there are four separate chambers for the mentally ill, all of which again depends on severity.
Isolation/ICU Room There is the isolation unit for those who are in extreme danger. This room includes one mattress and nothing else. The “privileges” of blank paper and crayons can be granted if the patient’s behaviour is to an acceptable level. The door has one window about the size of a head for the security to watch through, there are several cameras around the room, and two level 2 security officers & one psychiatric nurse must be on the unit at all times.
Example: I was put into the ICU when I was restrained due to violence towards myself. I lost all privileges including the privilege of utensils. I was left with a paper spoon, paper cup, and paper try of lukewarm food for three days. I also lost the privilege to colour, write, read, and all communication with the outside was taken.
Quiet Room The quiet room includes a couch weighted to the ground and one recliner chair, the walls are made of unbreakable glass and a security guard is assigned to the patient at all times. This room includes the privileges of hot drinks, food, colouring, reading, and a friend or family member can stay with you.
Observation The observation unit is several beds separated by curtains for all patients awaiting units. It is not secluded for mental health patients. This room includes iPad, phone, colouring, food, hot drinks, and warm food privileges. Visitors are permitted during visiting hours.
Example: The lights are never turned off in this unit due to the high amount of emergencies.
Emergency “Beds” I use quotations around bed because this is where the mental health patients who are legally bonded by a Form go when there is no room anywhere else. The room includes a chair and a side table with a TV attached to the corner of the room. One security guard per patient is needed at all times. Privileges include visitors 24/7, TV, colouring, warm drinks, and walking around privileges with a staff or family member.
Example: For two days my Dad and I sat in the observation room. He laid on a plastic tray for a pillow and I laid in a sit-right safety chair.