A patient arrives in a local emergency room after having made a serious attempt to take his own life by swallowing too many pills.

Doctors rush to get the dangerous drugs out of the patient's system, preserving his physical health. But they know he clearly has a mental health problem that must be treated to truly save his life.

When the patient wakes up, doctors plead with him to agree to stay in the hospital's psychiatric unit, but he refuses.

That's when the waiting begins.

Since involuntary psychiatric care services at Southeast Missouri Mental Health Center in Farmington, Mo., shut down last fall, local doctors are having a difficult time finding a hospital that will accept patients like this one.

"It happened all at once," said Dr. E. Lee Taylor, vice president and chief medical officer at SoutheastHealth. "That was a lot of beds that became unavailable concurrently on the involuntary side. Now we have very few of those places left to call."

Southeast Hospital has approximately 15 beds for voluntary psychiatric care, but patients must agree to treatment, and many times those suffering from a mental illness won't, Taylor said.

When doctors think a patient needs involuntary psychiatric treatment, they contact a probate judge, who reviews medical documentation and can then order treatment.

Hospital officials wouldn't specify how long it can take to discharge a patient to an involuntary psychiatric facility, just that they "often must wait a long time."

The closest hospitals to Cape Girardeau that will accept involuntary psychiatric patients are Poplar Bluff Regional Medical Center and Mineral Area Regional Medical Center in Farmington, Mo. If those beds are full, patients may have to go as far as Springfield, Mo., Taylor said.

Finding transportation for patients from Cape Girardeau to the hospital they're being transferred to also contributes to the delay, Taylor said.

"You may have to wait hours and hours to have transportation available. The result is you occupy a bed in the ER for a long, long time, even though you're not physically acutely ill," he said.

These mentally unstable patients do not pose a risk to others in the ER, however, according to a written statement from SoutheastHealth. Its emergency room has three specially designed doors and cameras to closely monitor psychiatric patients, Taylor said.

The Southeast Missouri Mental Health Center, operated by the Missouri Department of Mental Health, had a psychiatric emergency room and a 60-bed short-term psychiatric care treatment facility that closed in August. Similar facilities at Metropolitan Psychiatric Center in St. Louis closed at the same time as part of an effort to reduce state spending by $9 million.

"A major factor in this decision is that Federal regulations prohibit Medicaid reimbursement to state psychiatric hospitals that provide acute inpatient care, while community hospitals who provide acute inpatient psychiatric care do not face the same limitations," said Bob Bax, Missouri Department of Mental Health director of public and legislative affairs.

The space previously used for short-term psychiatric care is now used for minimum-security, long-term psychiatric patients. These inmates were previously housed in "inadequate facilities" at the Fulton State Hospital, Bax said.

Taking action

Community hospitals are taking action to fill the void created by fewer state beds, but neither Cape Girardeau hospital stated any plans to expand psychiatric services.

"Private hospitals face the same human and physical resource challenges that forced the Southeast Missouri Mental Health Center in Farmington to close," according to a statement from SoutheastHealth.

Saint Francis Medical Center declined to answer questions on mental health care.

Missouri had fewer than 22 psychiatric beds for every 100,000 residents, according to a 2008 study by the Missouri Hospital Association.

In 2006, 60,527 Missouri emergency room patients were diagnosed with a mental disorder, the same study showed.

In an effort to offset the loss of short-term involuntary psychiatric facilities, the Department of Mental Health is providing $3 million to Southeast Missouri mental health providers annually to "enhance community-based care and improve coordination and speedy access of services across inpatient and outpatient mental health services," Bax said.

Community Counseling Center in Cape Girardeau is one of seven Southeast Missouri agencies to receive a portion of this funding.

This funding will help provide increased capacity for appointments, mobile outreach through special crisis teams, crisis stabilization services where patients receive intense daily treatment at a place like Community Counseling Center rather than being admitted to a hospital, Bax said.

Health care providers in Southeast Missouri are meeting with Department of Mental Health on a regular basis to evaluate the success of these efforts, Bax said.

mmiller@semissourian.com

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Pertinent address:

1701 Lacey Street, Cape Girardeau, Mo.