There’s a shortage of psychiatrists and other mental health professionals across the country. That, along with the lack of treatment facilities, leave some people in crisis with no place to go. That’s why many end up in the emergency room. Nevada, in particular, is ranked 51st in the country, according to the 2018 Mental Health in America report for access to mental health care. Dr. Cari Croghan is an emergency room doctor based in Reno, Nevada and shared some of the challenges of her profession.
Editor's Note: The audio has been revised to clarify that hospital emergency rooms that take Medicare or Medicaid are bound by the Emergency Medical Treatment and Labor Act to provide emergency care regardless of an individual's ability to pay.
The Agency for Healthcare Research and Quality's 2017 report found that visits to the emergency room had increased nearly 44% from 2006 to 2014 by patients with mental health issues or substance use disorders. The overall number of visits to the emergency department increased nearly 15% in the same period.
As an ER physician for more than two decades, Dr. Cari Croghan said the emergency department frequently treats people with a range of physical and mental ailments. Some people without primary care providers, or health insurance to access help at urgent care, will seek emergency care as a last resort.
“Mental illness is everywhere. Substance abuse, and don't forget alcohol, because that is an enormous problem, especially in our society and this community, in particular. We have a lot of freedoms here, but that includes the freedom to lose yourself in gambling, meth, heroin, alcohol, and all sorts of things that end up causing health problems,” Croghan said. "In the end, substance abuse is part of mental health. If you're not able to control your life because you are addicted to something, then you need help with that. That is a mental illness. That is a psychiatric emergency.”
The Affordable Care Act (ACA), which was implemented in 2014, helped to decrease the number of uninsured people in Nevada. A year prior to that, about one out of five Nevadans were uninsured. Although the ACA and Medicaid expansion in the state reduced the number of uninsured people in the state, the 2019 Guinn Center Nevada's Uninsured Population report found that those lacking health insurance in the state still remains high compared to the rest of the nation. Nevada had the sixth-highest uninsured rate in the country in 2017, with about 14% percent of state residents living without health coverage. That’s nearly 400,000 Nevadans living without health insurance.
Nevada ranked last in the nation for access to mental health resources by the 2018 State Of Mental Health In America report. More mental health care providers and treatment facilities are needed statewide to adequately address the needs in the state. While emergency care providers are able to help a psychiatric patient in crisis become stabilized, Dr. Croghan said the emergency department is not the type of environment with the adequate resources to help patients receive the treatment needed for long-term recovery.
“We're not getting those patients who are staying there in our psychiatric beds ... what they need,” Croghan said. “We can restart them on medications. We can watch them and make them safe, but we can't give them the talk therapy that they need. We're not dealing with, 'how did you even get here.' ”
Despite the challenges and demands of working in the emergency department, Croghan acknowledged the satisfaction of being able to help her patients. “If you have a win every once in a while, it's literally life or limb. The stakes are huge,” Croghan said. “I think what keeps us going is knowing that when you do make a difference, it's such a big, big monster difference.”
According to the 2018 State of Mental Health in America report, for every 580 people living in Nevada, there is at least one mental health provider. In addition, about two out of three adults in the state with a mental illness receive no treatment.