Reinventing the E.R. for America’s mental-health crisis

The mental health epidemic is real enough in terms of presentation to the ER. The numbers are quite shocking. Where I live in Ontario, Canada, psychiatric emergency calls involving the police have increased about 200 - 300% over the last decade. Many municipalities cannot currently respond to ambulance calls adequately, in large part due to responding to so many psychiatric cases. [1] This is not for any particular underfunding or mismanagement; the call volume has consistently increased far greater than anyone anticipated or planned for. [2]

COVID-19 greatly exacerbated this, but the trend goes back to at least the early 2010s.

The role of emergency services is clearly transforming; becoming rather routine really. We have scenarios where people are engaged in behaviour where the response is ambulance or police, at rates many times that happened just a couple decades ago.

I don't really know what to make of it. I think probably in part, it reflects genuinely worse mental health in society. But I think it may also reflect a change in perspective/view. I think we are more likely to believe we need expert outside intervention when presented with disturbed individuals; previous generations may have been far more reluctant to call the police because they would have not interpreted such a scenario as a situation that requires police or outside intervention. (The cops, as they will usually admit, know no more about how to handle a crazy person than the average person does.)

I'm not sure about elsewhere, but one major hole in the healthcare and social net here in Canada is that there is very little care available between acute crisis and normality. There are services (largely overwhelmed these days) to help people at the very bottom. But not much in the way to prevent their slide to the bottom in the first place. About half of people who present to the ER for a psychiatric reason in Ontario have never seen a doctor before for their mental health. [3] And it's not typical that they just snapped suddenly one day. They had usually been suffering for weeks or months, possibly longer, before ending up in the ER. We do need something like mental health urgent care, or ambulatory clinics. Like the clinics for when you have a broken bone, but aren't dying. Take some load off the ER.

[1] https://www.theglobeandmail.com/canada/british-columbia/arti...

[2] https://www.cbc.ca/news/canada/ottawa/paramedic-chief-ottawa...

[3] https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

The asylum system was so much worse for the victims than homelessness that it's not even funny.

It existed just to hide these facts of life from the most fortunate and spare their feelings.

All at the expense of the committed that were horrifically abused.

And no, you won't do it right this time.

Something is seriously wrong with our culture the past 10-15 years to have contributed to such a dramatic rise in mental illness.

Is there a rise in mental illness or more people simply being diagnosed now? We're more aware of mental illnesses, leading to more diagnoses, leading to what appears to be a spike in mental illness. I haven't dug deeply into this but I wonder if studies on this have attempted to separate the two. Psychology is notorious for it's crisis of reproducibility. I take everything related to mental illness with two heaping scoops of salt.

I wonder how much can be attributed to legalization/decriminalization of drugs. Because if someone is on drugs but that is “fine” now are the classified as a mental illness incident?