At a time when there is a critical shortage of mental health services and more than 40,000 patients a year are boarding in our state’s hospital emergency departments for days and even weeks, Cambridge Health Alliance (CHA) has announced plans to close its highly regarded, and highly utilized, psychiatric emergency services unit (PES)  a move nurses and mental health advocates believe will decimate the quality and safety of care for psychiatric patients who are in crisis.
Located on the CHA’s Cambridge Hospital campus, the PES is a unique unit that depends on skilled RNs and staff members to provide specialized care to those with mental illness. This practice stands in sharp contrast to how psychiatric patients are treated at most other hospitals in the state where, instead, they are simply boarded in overcrowded emergency departments with little or no immediate access to comprehensive care.
Specialized services offered by the PES include 24-hour care for people in severe behavioral and emotional distress; care to people of all ages from across the entire Greater Boston region and beyond; a full range of comprehensive emergency evaluations, interventions, and referrals; psychiatrists on duty 24-hours a day to help manage all acute mental health emergencies; medication assessment and management; and referral and admission services. Additionally, the actual unit  as well as how it is managed  was created with the unique needs of crisis-afflicted mental health patients in mind.
“The unit’s rooms are all private and are entirely contained,” described Lyons-Connors. “All access doors are secured with multiple locks and are monitored through a variety of fashions; any and all items that could be used as weapons to self-harm are completely removed; noise and distractions are controlled so that a patient’s situation isn’t worsened by overstimulation; and the RNs and staff who work on the unit are experts at providing the kind of unique, specialized care that these patients require.”
According to CHA’s web site, the hospital will cease operations on the unit on June 4, 2014, at which point, “the PES will move down the hall into the [regular] Emergency Department at the Cambridge Hospital Campus … All patients seeking emergency care should go to the main entrance of the ED, which is in the Cambridge Hospital lobby.” In addition, the hospital also plans to lay off all of the unit’s psychiatric nurses, social workers, and milieu counselors  a move that will 1) leave the hospital depending more on its public safety officers and 2) will likely lead to an increase in the use of restraints with patients suffering an acute mental health emergency.
“The hospital views this as nothing more than a simple merger of the two units that provide emergency services,” said Ellen Lyons-Connors, a registered nurse who has worked on the unit for more than 15 years. “But the truth is, elimination of the PES represents the total loss of a specialized unit that was created with the unique needs of the area’s mentally ill in mind.”
The hospital’s announcement just barely preceded “Mental Health Advocacy Day,” an annual event coordinated by the Massachusetts office of the National Alliance on Mental Illness (NAMI). As part of its early-April “Advocacy Day” efforts, NAMI released a corresponding report that quantified just how much decimation the commonwealth’s fragile mental health system has sustained recently:
• After slashing its mental health budget in 2009, Massachusetts now ranks last in percent growth for mental health funding out of all of the New England states.
• There has been a 40 percent decrease in the number of public beds available for mental health patients since 2005.
• This reduction in beds/services has been a key reason as to why more than 40,000 psychiatric patients are needlessly boarded in hospital emergency department beds annually.
“If closure of the PES goes forward, patients and their families will suffer unnecessarily,” said Jo Ann Emerald, a longtime PES RN. “Waiting times will be longer, assessments will take longer, and medication delivery will take longer. At best, this will leave psych patients who are in crisis languishing in a general ED that is too open and too dangerous. At worst, it will lead to increased violence by patients. Either way, it is wrong.”
“It isn’t like there are a lot of options for these patients,” added Lyons-Connors. “There’s nowhere left to go. The beds at other hospitals are gone and the services everywhere else have been slashed. Cambridge is just the latest in a long line of hospitals that are willing to sacrifice the needs of the mentally ill all in the name of cost savings.”
MNA RNs, other hospital staff members and local mental health advocacy organizations have all announced their commitment to fighting the proposed closure. Grassroots organizing initiatives, including a petition campaign, are underway. Visit MassNurses.org for details.
