Residents of Baltimore City with mental illnesses suffer from a lack of treatment options to address non-emergency concerns resulting in increased costs, lost time and delays in care. For decades, we have used urgent care clinics for minor medical problems to avoid trips to the E.R.; the same should be done for mental health problems.
Psychiatric urgent care clinics in Los Angeles, Albuquerque, Houston, Nashville and other areas provide same-day services to walk-in clients and to those brought in by police or ambulance. They offer rapid evaluation by a mental health clinician and psychiatrist, same day prescriptions, short-term case management, respite for those in the midst of crisis and referrals to ongoing providers. These clinics accept both private and public insurance, and they are available on days, evenings and weekends.
Baltimore does not currently have such mental health urgent care clinics, representing a significant gap in response to our residents’ needs.
The two scenarios described below show how urgent mental health care clinics could decrease E.R. visits and reduce delays in much needed treatment.
“Mary” is a middle-class woman with private insurance. It’s the anniversary of Mary’s son’s death, and she is feeling overwhelmed. She calls a crisis hotline she remembers seeing advertised, but they don’t have a team available. Mary realizes this is not the best choice for her anyway because they are a residential program and she has a job to maintain, and they do not accept private insurance. Desperate, she goes to the E.R. where, after 10 hours, she sees a doctor. She is not feeling suicidal, so the doctor discharges her with a list of outpatient psychiatrists. After calling several offices in order to find a doctor that accepts her insurance, she gets an appointment with a psychiatrist scheduled for two months away. After struggling through the next two months, the doctor tells Mary that he specializes in treating PTSD, something that was not mentioned when she made the appointment, and that he would not be a good fit for her. Frustrated, she gives up, remains distraught and is stuck with bills for an E.R. visit.
If an urgent care center were available, Mary likely would have been able to meet with a mental health therapist the same day. The therapist would have created a short-term treatment plan focused on connecting Mary with an outpatient provider. Additionally, Mary could be referred to a support group at the urgent care center so she is supported while waiting for her initial appointment with a community therapist.
Now consider the case of “Mike.” He is homeless and has Medicaid. He has schizophrenia and enjoys smoking synthetic marijuana, but when he smokes, he becomes paranoid and believes people are trying to kill him. Scared, he seeks care at an outpatient clinic but is told there is no opening for two weeks. Mike returns to the street where, as a result of being intoxicated and paranoid, he begins causing a commotion. A store owner calls the police saying a man is disturbing his customers. The officers understand Mike is not necessarily a threat to himself or others but know he needs help. The only available option is the E.R. So police handcuff Mike and bring him to the hospital. There, the officer waits with Mike until he is seen by a doctor, taking the officer off the street and away from other work. In the E.R., the high from the synthetic marijuana wears off. Mike is still hearing voices but is calm, and the doctor decides he doesn’t need to be admitted. He is given a list of community resources and is discharged to the street to begin the cycle over again.
At a mental health urgent care clinic, Mike could be assessed quickly, freeing the officer to return to duty. He likely would be observed in a safe environment for 24 to 48 hours. Once sober, a therapist could connect Mike directly to outpatient treatment while a psychiatrist at the clinic writes a prescription for the antipsychotic Mike was taking during his last hospitalization. Mike could also begin attending Narcotics Anonymous meetings at the clinic.
In Maryland the number of individuals seeking treatment for a behavioral health diagnosis rose by 18 percent between 2015 and 2018. Unfortunately, a study by the Mental Health Association of Maryland found that only 14 percent of psychiatrists listed with health insurance plans were accepting new patients and had the ability to see a new patient within 45 days.
This is unacceptable gap in care — one that should be immediately addressed.
Morgan Gregg is a social worker in Baltimore City and the chief clinician on the Baltimore police department’s Crisis Response Team. Her email is firstname.lastname@example.org.