Matt is a 27-year-old with a good education, a promising job history and — on this particular afternoon — a heroin overdose that has sent him to the emergency room.
His distressed parents, who called 911 when they found him unconscious, tell hospital workers that Matt has bipolar disorder. The disease was well-controlled until he was hurt in an auto accident some months earlier. He became dependent on prescription pain killers and soon switched to heroin because it was cheaper and easier to buy.
After the accident, Matt’s life fell apart. He stopped taking his medications, was fired for threatening his boss, and moved back with his parents, who are now scared of him because he has threatened them (though he’s never hurt anyone).
A shot of naloxone awakens Matt from his overdose. Two hours later, alert and agitated, he refuses the hospital’s offer to transfer him to a detoxification program. He gets into a shouting argument with his father, frightening other patients and staffers in the emergency department, and stalks out alone — presumably to find a new fix.
Major threat to safety
“Matt” is a composite figure drawn from several cases described by Massachusetts health professionals that illustrate the challenges emergency departments face treating a growing number of patients with behavioral issues that stem from a combination of psychiatric illness and opioid addiction.
Emergency departments (EDs) are on the front lines of this challenge, which strains their resources and makes it harder to serve other patients.
The problem also poses a huge patient safety risk. The ECRI Institute, a national organization that examines safety, quality, and cost-effectiveness in healthcare, identified the problem of “inadequate management of behavioral health issues in non-behavioral-health settings” as among the top 10 threats to patient safety for 2016. The Institute describes the behavior as “frightening or frustrating for the staff, especially if they are ill-equipped to handle them,” and added that it “can lead to injury or even death of patients or staff.”
The problem has led to the testing of new models at community hospitals like Beth Israel Deaconess Hospital-Plymouth and Holyoke Medical Center aimed at improving health care quality for patients as well as the safety of staff members.