ER Rights for Mentally Ill People

At the State House, lawmakers are considering a bill aimed at curing a little-known problem in emergency rooms. It’s about how people with mental illness are treated when they go to the ER for medical reasons: Sometimes, they experience discrimination.

The proposal now on Beacon Hill would better regulate the care of mentally ill people and, advocates say, protect their dignity. But the hospitals and state agencies that oversee ERs say they need more training and guidelines, not another state law.

WBUR’s Monica Brady-Myerov begins her report with the story of one woman’s experience.

MONICA BRADY-MYEROV: Rachel Klein had a headache. It was three years ago but she remembers it was a very bad one, which had gone on for two weeks.

RACHEL KLEIN: I was so sick I couldn’t eat. I couldn’t stand bright lights. I was in excruciating pain.

MONICA BRADY-MYEROV: The 39-year-old MIT graduate did what anyone would do: She called her doctor. He told her to go to the emergency room. An intake nurse asked her what medication she was on.

RACHEL KLEIN: I was on anti-depressant medication, anti anxiety medication. I have depression and post traumatic stress disorder, and I take a bunch of different medication for those.

MONICA BRADY-MYEROV: At the ER she waited in a dark trauma room with her head pounding. Six hours passed.

RACHEL KLEIN: I was just getting really pretty frustrated and upset that I was just laying there no nurse came to see me, no one asked me to change in a Johnny. I went out to the nursing station I was a little annoyed and I said I need to see a doctor — I’m in a lot of pain.

MONICA BRADY-MYEROV: The first doctor she saw was a psychiatrist who asked her if she was depressed or considering suicide. She said no, she had a headache. Then, Klein was put in the psyche ward of the emergency room despite her pleas that she was in for a medical problem. Klein said she didn’t want to go because she was worried they would put her in restraints. She says she was raped while in restraints at another hospital. At the ER, the nurse called security guards.

RACHEL KLEIN: And they grabbed me, bodily. I had bruises two weeks later. I was kicking and screaming, “Get off of me, leave me alone, what are you doing?” And they dragged me to this room where they stripped all my clothing off. Like gown to bra, underwear, everything. I started screaming, “Don’t rape me, please don’t rape me!’ I was in a flashback.

MONICA BRADY-MYEROV: The state acknowledges this kind of treatment has happened. Officials have confirmed cases of strip searches, isolation and restraints regardless of patients’ medical needs. All this goes under reported because of stigma, say advocates for people with mental illness. But these incidents are not the norm, according to those who oppose further regulations. Among them, David Matteodo, who leads a coalition of hospitals and ER physicians.

DAVID MATTEODO: I think there have been unfortunately a few very isolated incidents that were not exactly handled tremendously by hospitals; however, the overwhelming majority of psychiatric patients are treated fairly.

MONICA BRADY-MYEROV: Matteodo would have a hard time convincing Rachel Klein to go back, after what happened to her in the ER. She was stripped; she was given an anti psychotic medication to calm her down, and tied to the bed.

RACHEL KLEIN: At that point I was in the restraints. I was calm, so I said “Will you please let me out of the restraints? I’m calm I know where I am. I need help for my headache,” because my head was still killing me.

MONICA BRADY-MYEROV: After 16 hours, she was given a prescription for 40 powerful painkillers, and sent her home. Klein says she was never examined by an internist for her headache.

Since then, she’s been part of a group working to establish guidelines on treatment and improve training. She and other advocates want a new state law for protection but they are also working with physicians, consumers, hospitals, and the Department of Mental Health to draw up guidelines. DMH Commissioner Barbara Leadholm says it’s this kind of cooperation that will improve treatment, not a new state law.

BARBARA LEADHOLM: It’s a very large group of constituents, and how we’re approaching these issues is opening up the conversations, understanding the actual experiences and trying to say, “What in fact is happening and what kind of changes and opportunities for improvement are before us?”

MONICA BRADY-MYEROV: The legislation would create new, as yet undefined, regulations about how people with mental illness should be treated in emergency rooms.

For WBUR I’m Monica Brady-Myerov.

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