As budgets for mental health services get cut year after year, with no preventative care or dedicated psychiatric treatment centers accessible, hitting rock bottom and landing in the ER is the only option for many people.

We’ve designed a system that requires people to hit rock bottom as a prerequisite to getting help, but even when they hit that rock hard, it’s likely there isn’t any help to be had. Then they get stuck waiting in the ER.

A 2010 survey of ERs in the US found that 70% were likely to keep people for 24hrs or longer. 10% boarded patients for a week or more. The non-stop energy, confusion, and uncertainty of an ER is hardly the best place to be when you’re in mental distress. And accommodations are likely to range from none, like in this case of a young woman suffering a breakdown and spending 10 days in the ER waiting area: www.dailymail.co.uk/news/article-3231007/Mom-Daughter-waited-10-days-ER-mental-health-bed.html, to medieval, like in this story of being stuck in a hospital ER’s “Yellow Pod”, with nothing but a mattress bolted to the floor, a plastic cube, and the smell of urine: www.concordmonitor.com/home/4741184-95/hospital-state-mental-pod

For any person with great mental health, those experiences would be traumatizing. So how much additional damage does a person with mental illness suffer when they’re in distress and land in the ER? In the search for help, how much further down the hole does the system push them?

One way of beginning to address some of the challenges in the ER is by bringing in peer navigators–people with lived experience of recovery from mental illnesses that can advocate for better care for those who are unable to and can help the patient understand what’s going on and why. Adding peers to healthcare teams is an exciting change in how we deliver care. You can read more about peer navigator programs in this PDF report: The Value of Peer Support for Improving Emergency Department Experiences for Racialized People with Mental Health Issues

How can we redesign the Emergency Room experience to be supportive and healthier for people dealing with a mental illness?

And, it’s important to remember that the changes we need to make in our healthcare system need to happen everywhere. When people are landing in the ER with their mental illness challenges, it’s an indicator that we’ve already failed at multiple other points throughout our communities and healthcare systems. We’re not proactively tackling these issues.

If the ERs were filling up with people recovering from drowning accidents, the question shouldn’t necessarily be how do we get more beds to handle those problems, but how do we get more swimming lessons out into our communities?