Non-physical injury emergency room visits

Emergency rooms are not places that can easily deal with social problems and personal life crises. If you go to the emergency room because you’re in a panic over your life situation you’re going to, in all probability, end up with a psychiatric label. Psychiatric labels and hospitalizations can actually set people further back from any real solution to their social dilemmas than can the opposite of a psychiatric label and hospitalization, that is, self-reliance.

I was talking to the head of a university hospital’s resident psychiatrist program in a relatively small town, and he told me that approximately 2500 people roughly passed through the emergency room in that hospital with a psychiatric problem in the course of any given year. This approximation peaked my curiosity as to how many people in the USA might take their personal problems to a hospital emergency room.

An article in the LA Times, Millions of yearly visits to the ER involve patients with mental disorders and substance abuse problems, has helped answer some of the questions I had on the subject.

Not every emergency room visit involves a physical problem. Out of 95 million visits made to emergency rooms by adults in the U.S. in 2007, 12 million, or 12.5%, had to do with mental disorders, a substance abuse problem, or both.

These statistics are part of a report, according to the article, put out by the US Agency for Health Care Research and Quality, part of the Department of Health and Human Services.

Whether you believe in mental illness, or whether you’re a skeptic on the subject like myself, there can be little doubt that hospital emergency rooms serve as a major recruiting ground for converts to The Church of Mental Illness. We’ve just established that well over 1 in 10 people in an emergency room are usually there for an emergency that doesn’t involve a specifically physical complaint.

Of those 12 million visits, about 66% involved patients with mental disorders, about 25% involved patients with substance abuse issues and the rest involved patients who had both a mental disorder and a substance abuse problem.

Simple math, subtracting 66 from 75, would give a percentage for the rest, those patients labeled mentally ill who also had substance abuse issues, of about 9%.

The next statistic is a little disturbing and curious as well.

Almost 41% of those 12 million visits resulted in the patient being admitted to the hospital, which is more than 2.5 times the rate of hospitalizations for other conditions.

I’ve heard people complain about people not being able to receive psychiatric care. I haven’t heard so much about people complaining about not being able to receive physical care. I’m wondering what statistics might exist on those matters.

I think it would be helpful if I laid the information revealed in this article out in a way that people might be able to access it more readily.

95 million (100%) overall adult emergency room visits
12 million or 12.5% of those visits—problems not physical in nature
66% of that 12.5% involve mental disorders
25% of that 12.5% involve substance abuse
09% of that 12.5% involve both mental disorders and substance abuse
41% if that 12.5% resulted in hospitalization, a figure 2.5X higher than that for physical complaints
54% of that 12.5% were women
47% of that 12.5% were between the ages of 18 and 44
35% of that 12.5% were between the ages of 45 and 64
30% of that 12.5% billed Medicare
26% of that 12.5% billed private insurers
20% of the 12.5% billed Medicaid
21% of that 12.5% uninsured

Insurance is obviously a big problem here. Fully 50% of this 12.5% are using Medicare and Medicaid, public insurance programs funded by Joe Q. Taxpayer. 21% are completely uninsured, and who is going to pay their way if not Joe Q. Taxpayer. That leaves only 26%, or almost of a quarter of this 12.5%, who aren’t subsidized by Joe Q. Taxpayer. So 74% of this 12.5% of people who wind up in the emergency room are a financial burden to be carried by the taxpayers.

The top 5 conditions that make up 96% of this 12.5% in order of occurrence are:

1. mood disorders
2. anxiety disorders
3. alcohol disorders
4. drug disorders
5. schizophrenia & other psychoses
6. intentional self-harm

If, in a preventative capacity, more alternatives to hospitalization were made readily available, I imagine that this 41% hospital admittance rate (2.5X that of non-mental health/substance abuse cases), could be sharply reduced.

I’d like to point out that making a career of psychiatric disability is not accounted a smashing success in most people’s career accounting books. I happen to think that, in such instances, a person’s chances of making a significant career change are relatively good, given fortuitous circumstances, and an average amount of desire and drive.