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Emergency Room Overload: the Plight of the Mentally Ill

Annette Sharp holds a BAAS in Behavioral Science from Texas A&M. She is a counselor and motivator with an empathetic heart.


Misunderstanding the Plight of Mental Illness

(Please note this Hub is NOT a criticism of Emergency Room staff in any way.)

There's an epidemic out there today. It's everywhere. Misunderstood and shunned, mental illness is as common as any other disease or illness. The problem is a lack of understanding and acceptance. Let me give you some examples.

People with severe mental illnesses like Bipolar, Schizophrenia, or Major Depression have a sickness. Compare it to heart disease, diabetes, and high blood pressure. It's been around since the beginning of time. Mental disorders are an illness, not a label.

Scenario: A patient with Bipolar Disorder is off his medications and having suicidal ideations of shooting himself. He goes to the local ER and reports his symptoms. After finding nothing medically wrong with the patient, a mental health or social worker is called to make a determination if the person needs psychiatric hospitalization. After the assessment, the worker consults with ER staff and the doctor about the disposition of the patient. The concern is this:

Some instances of this sort are not actual suicide plans, but the patient's outward cry for help and attention (malingering). Because of this, medical providers (not trained to deal with the behavior of mentally ill individuals), feel overwhelmed and unsure when faced with these crisis situations. The result is a lack of empathy and compassion towards the client that affects the attitude of the hospital staff. Why is this happening? Let me explain.

When a person becomes suicidal, homicidal, or a danger to themselves or others, local law enforcement and crisis hotlines direct or assist the individual to local Emergency Rooms for evaluation. Unless the community has a psychiatric, behavioral, or mental health facility equipped to deal with the situation, regular hospital ER's are the only alternative. When this happens, community Emergency Rooms are bombarded with mental patients, drug addicts, and lastly, indigent people looking for a meal and a bed masquerading as mentally ill. It's the latter of the three that most stimulates the resentment of medical personnel, understandably so! This group of individuals (malingerers), which make up a small percentage of people who end up in the ER, are familiar with the procedures for handling psychiatric clients in crisis. Therefore, they know just what to say in order to "be committed" to state institutions, which puts a strain on the availability of beds for those who actually need them, thus, filling up Emergency Rooms with mental patients waiting for transport to a psychiatric hospital, taking 'beds' away from people who actually need them! This is a real dilemma in cities who don't have a Psychiatric ER. The result: negative attitudes and labeling.

In reality, every suicide threat needs to be taken seriously. Whether the individual actually acts on his thoughts cannot be easily predicted. What if the person is saying he wants to kill himself just to get attention? Think about this....if someone feels desperate enough to go to this length to be noticed or get help, doesn't that demonstrate severe instability?

Regardless of preconceived ideas about mental illness, the problem exists. What is the solution? More funding for state hospitals? Mental health education for healthcare providers? It boils down to one thing: a lack of understanding and acceptance of mental disorders. The question is "What are we going to do about it?"

For more information on mental illness go to

Other Suggested Reading:


Annette Thomas (author) from United States on August 18, 2013:

Thank you Patrick! What a wonderful gesture to reach out to me so many years later. And better yet, to know I've said something that could motivate you. I'm so happy to see you doing okay. I will, indeed, check out your FB page! God bless you for your extension of kindness.

Patrick Kelly on August 18, 2013:

Annette-donotfear You wrote a wonderful comment on a blog I wrote many years back. I appreciate everything you said it was very interesting seeing it so many years later actually just today . A small price we pay taking Bipolar medication is we overlook what we've done an don't pay attention to the things we have not to mention writing letters or getting back on a return script from the past * TADA Hence forth my plea to forgive me. I tried my best to keep up often falling back obviously since the post you commented on was in 2009 / only to get back at ya in 2013 opps. Sincerely yours Patrick G. Kelly / Dirtdog from Blogger ' Your work here is wonderful I have a lot of respect for your style. I have be putting effort into my facebook community called Bipolar banana page and on facebook also as to my blogs they are still there an I am taking your comment as Inspiration to possibly try once again. I did start something on Hubpages but frankly at this time I can't remember ? Cheers to you n your n please feel free to stop by n holler at me on facebook at Bipolar Banana page Cheers Patrick

Annette Thomas (author) from United States on May 30, 2012:

Sage in a cage: Yes, you are so right. It doesn't matter who the person is, homeless or wealthy, they deserve to be treated like a patient who is sick. With compassion. When it becomes evident that the patient is "looking for room & board" or a free meal, then firmness can be applied in a way as to not offend their sensitivities.

Sage in a Cage on May 30, 2012:

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Good hub. I've worked with many vulnerable individuals who, even many years, later will recount tales of insensitive treatment when they looked for help at an emergency room. I appreciate the pressure that hospital staff are under but I do wish more training was given on social skills and sensitive interviewing when dealing with incoming patients with mental health issues.

Annette Thomas (author) from United States on April 22, 2012:


Thanks for your contribution and observation. It's a difficult and controversial situation, for sure. You never know what someone may do, that's the whole issue. Best to be safe than sorry.

meloncauli from UK on April 22, 2012:

Great hub. I'm not sure I agree about disregarding the seriousness or urgency of someone who mentions they are having thoughts of suicide but who doesn't have a plan. There is also a chance when depressed that someone can act on impulse. These people don't have a plan. Some people are more impulsive by nature than others and consumption of alcohol can be all it takes too. In my experience this is more likely of males rather than females. Just a thought but very interesting hub and thanks for sharing.

Poohgranma from On the edge on January 17, 2011:

A wonderfully written, informative and accurate hub. Plus you got great dialog going which is so important. It saddens me greatly that our country neglects our Mentally ill and that the stigma still exists to such a large degree in a supposedly enlightened society. You play an important role here and I hope you can get published in magazines where your information can reach more people!

Denise Handlon from North Carolina on October 05, 2010:

donotfear-I think you and I have some common threads. This is a well written hub exposing some of the dilemmas that the M.I. face and the problems which a poorly experienced ED room deals with. As a psych nurse I can vouch for the truths of what you write here. There are people who fake it and get into a psych unit taking up a bed that could be used for a person who genuinely needs it. It is upsetting and frustrating to the staff who work the inpatient unit. Many of these folks are attempting to get disability and know that they have to have X number of hospitalizations to pat their hand when they plead their cause.

I wrote a piece on the Commitment process. It explains a little about when a person is actually committed on an involutary status.

Although this hub has been written 2 years ago the information you offer is just as valuable today. Well done!

Annette Thomas (author) from United States on September 19, 2010:


Well thank you for the read. I'm sorry you didn't have a good experience with Respite., but very glaed you got yourself together!! Great!

schoolgirlforreal on September 18, 2010:

true. Wonderful hub, true.

I went to a respite 4x in 4months...asking for help that I never got...finally I made up my own mind what I should do. It is very misunderstood

Annette Thomas (author) from United States on July 27, 2010:

Always Greener: You got that right! Social policy has a lot to do with it. Misunderstanding & ingnorance play a large role, too. Please do make a difference! I welcome & appreciate an attitude such as yours. Thanks.

Always Greener on July 27, 2010:

We are living in the dark ages in regards to mental illness. It's not a 'cool' or 'trendy' topic yet for people to discuss - and the problem's getting worse too, because you look around and see people who obviously have symptoms of anxiety and depression. That's why I'm planning to make a career where I can advice on social policy and help improve the plight of mentally-ill people - the only way it will change is through policy. The situation is an absolute mess now, really.

Annette Thomas (author) from United States on April 23, 2010:

Thanks seanorjohn! Sorry about your loss with your brother in law. Glad I could share with you. Why wouldn't you want me to follow you? I like whimsical nonsense!

seanorjohn on April 23, 2010:

Donotfear,' wow I never thought people could be so devious to fake mental illness, just for the sake of free bed and board.

I lost a great brother in- law, who was like a son to me through mental illness and alcohol poisoning.

love your considered replies on the forums.

Glad to follow you but truly don't reciprocate. I only write whimsical nonsense.

Annette Thomas (author) from United States on March 31, 2010:

Thank you, Patrick Collins, for your input. Absolutely correct. It helps to know there are more kindrid spirits out there who understand. It's like I say in the article, it's misunderstood and difficult to deal with.

Patrick Collins on March 31, 2010:

great hub and 100% spot on.

I work in the hospital system and particularly with psych patients.The majority of hospital "professionals" have no idea about the plight and suffering of the mentally ill . ER staff are mainly trained and interested in the medical field and many mental health staff are unsuitable for the job.

It's an uphill battle for the mentally ill, but if you are reading this and are suffering , DON"T GIVE UP . There is help out there . Feel free to contact me and I'll advise you the best I can.

There are many 'frequent flyers' in the system that abuse the hospitals as hotels, and there are many that should just be in prison.Hospital staff are cold and burnt out on behavioral issues as they are constantly being spat on, punched and threatened. Yes some of the people doing it are ill but people do dread dealing with some of these patients.

Rik Ravado from England on February 13, 2010:

Great Hub. Very similar situation in the UK. Mental illness is increasing but not enough resources are available to properly treat it. Someone close to me is bipolar and has horrendous experiences. Fortunately she now works as a mental health care professional and brings an informed and sympathetic understanding to caring for the mentally ill.

Sarah H on February 08, 2010:

This is so true. I'm glad you wrote about it.

NateSean from Salem, MA on February 01, 2010:

Malingering is a common term what you described in an earlier paragraph about people who know how to work the system to get free room and board.

But there is a fine line between someone who discusses suicide and someone who threatens to kill themselves. I've made the mistake of mentioning suicide to people who didn't know the difference and it made things hard for me.

Timothy Donnelly from Ontario, Canada on December 11, 2009:

Wow, go figure. Keep praying my good lady.

FYI, there was a news report very recently up here that proved the government would SAVE taxpayer money by just HOUSING homeless people (most of whom have mental ailments) for free! This is simply because the homeless, as a group, use more hospital time and need more medical attention than those with a roof over their heads. Don't forget, up here we have colder temps and free (government paid) Health coverage (which is not as complete as one might think).

Our Health systems are presently overburdened, and partly because of this, the people with mental health issues get bounced around from arrest, to hospital, to hostel, to back on the street on their own. Unfortunately, it looks as if they are bound to SUFFER more and more as they get marginalized by the sheltered and too often what seems to be cocooned powers that be who do not have to deal with them or be affected by them. I think the Mental Health care-giving community could use more loyal advocates to lobby and motivate the governments to look better after this sensitive dilemma.

Timothy Donnelly from Ontario, Canada on December 11, 2009:

Donotfear, thank you for this article, it sheds light on a such a pervasive tragedy. I would like to share a link that might help some families cope, because oftentimes the families are the only ones left to help:

Unfortunately, ALL TOO OFTEN, family members are not there, usually I think because they are simply unable, for many reasons.

On a good note, I have witnessed on occasion that a great deal of Love and Patience seem to help with the episodes of the stricken, God bless them all.

I have personal experience with a loved one suffering from a number of ailments, specifically what has been diagnosed as a Personality Disorder. From this experience, I can say that it is probable that there are different underlying ailments that may have brought on, or exacerbated the most obvious problem (the mental disorder). But alas, once gone too far, the afflicted effectively loose the ability to make the conscious healthy choices they need to make in order to live an independent life, as adults can normally do.

This is a BIG problem for families and communities. Hopefully, the education system can teach young people in elementary and high schools the reality of these things. I dare say also, that governments also MUST step up and dedicate MORE resources to help these unfortunate PEOPLE.

Donotfear, I am glad to have discovered your Profile, and I hope that you can share more of your knowledge in subsequent Hubs to propagate more useful information on this important personal, medical, and community issue.

Bovine Currency on November 25, 2009:

Having worked and studied in the field of community services, and being through psych wards, drug addiction and homelessness I can tell you something about homeless people. Great idea for a hub, just some feedback; drug addiction is a mental illness, like alcoholism (according to the Diagnostic Manual DSM for psychiatry). Many psychotic patients also suffer drug addiction, it is coined co-morbidity. Regarding the homeless, statistically, the majority suffer mental illness. Whether or not a person is in the midst of psychosis or serious suicidal ideation, the illness is still there. Many homeless people suffered bipolar disorder, major depression, schizophrenia. It is a real problem that the homeless are homeless. What you say here on this hub, it is the right idea but there is more. There needs to be more housing services for those suffering psychotics disorders but not in psychosis. For a schizophrenic, as an example, and you can find this information very easily; there are two groups of symptoms, positive and negative. Postive are adding to the person, voice, delusions, etc. Postive as in a creations, things that are not real. These symptoms are symptoms of schizophrenia and mostly present in the psychotic phase. Negative symptoms are much like depression and also exaccerbated by anti-psychotic medications. Negative symptoms include lethargy (physical tiredness), also lack of motivation, loss of interest in usual activities, lack of libido, there are also a list of other symptoms but you should get the point. Negative symptoms are more present during the phase where psychosis is not present. Schizophrenics are not always psychotic. Psychotic disorders are very complicated. In the phase where a schizophrenic may be in remission from psychosis, there still may be latent psychotic symptoms. One example might be the person is still hearing voices or seeing things that are not real, or maybe suffer delusions but have a little insight, thinking it is real but knowing that others would never agree. These are your homeless people. The issue is not beds in a hospital or pretending mental patients. The issue is lack of understanding, lack of application by government service, lack of housing for the misfortunate. There has been so much research done to support evidence for better social housing yet the application of governments is little to none.

A Texan on October 08, 2009:

I never considered the homeless faking mental illness to get a place to stay, But it makes perfect sense. Great hub

Annette Thomas (author) from United States on September 26, 2009:

Thank you Sister!!!!

Pastor Dr Carlotta Boles from BREAKOUT MINISTRIES, INC. KC on September 26, 2009:

Hello donotfear and Blessings!!! GREAT MINDS THINK ALIKE!!! lol, lol, You know I would love this Hub for I have too written on this subject! This is a such needed discussion! I thank God for leading you to presenting this matter!!! GREAT HUB!!! You Go Girl!!! My Sister!!!!

Annette Thomas (author) from United States on September 08, 2009:

Right on...!!!

Gareth Martin from Dublin, Ireland on September 08, 2009:

Great article - it’s made me realise that the way the mental health problem is prioritised in the US & Ireland is not that dissimilar. I’ve heard that “The Treatment of Prisoners is a test of Civilization of a society” perhaps this could be "the treatment of a cultures mentally unwell is a test of its level of civilization".

Annette Thomas (author) from United States on September 03, 2009:

You're right. Nobody wants to talk about it, but mental illness is just as real as high blood pressure, heart disease, and diabetes.

loua from Elsewhere, visiting Earth ~ the segregated community planet on September 03, 2009:

This one needs to go to Washington with advocates for change in the field of medical practice... It would open an eye or two on the issue.

I must say, the writing has been on the wall for a long while, it needs attention more than ever... I guess thanks for reminding me... Its something that I would like not to think of - here is were the problem lies , out of sight out of mind...

Annette Thomas (author) from United States on August 03, 2009:

Ghost, your wonderful wife has been through a lot. I would consider her case very difficult. I'm sorry you've had such a rough time dealing with ERs. I've seen first hand what happens in emergency rooms, and it's tough. This is a prime example of what I was talking about in my article: the small majority of those who claim to be "mentally ill" or people who claim to need "meds" or "hospitalization" (when it's not really the case) are creating a sense of 'suspiciousness' in doctors, nurses, staff and even mental health professionals. They, the health professionals, get so frustrated with the few individuals who abuse the system that some bias attitude bleeds through to the next patient who REALLY NEEDS the care. I'm so sorry you guys have had so much turmoil. From what you say about your dear Pam, it appears she has many other health problems besides her MH diagnosis. I don't blame you for giving up on the system, it's very self-defeating. I wish their was more I could do in this world to change this problem. After all, that's why I chose this profession: to make a difference. Prayers and encouragement for you and your sweet Pam!! Tell her there are lots of folks out here who DO care and understand.

Ghost32 on July 29, 2009:

Hm. Well, Donotfear, you may not want to allow this comment--it's your Hub and your right and I won't be offended--but I do have a great deal of criticism of ER staff.

Firstly, let me say that my kid sister and her oldest daughter are both lifetime Registered Nurses with many years of ER experience between them. No criticism toward my family or toward a number of other ER folks...but....

My wife, Pam, is bipolar, paranoid schiz, and used to have multiple personalities (She kicked out the latter single handed a few years back; tough girl.) She was also homeless for nearly 3 years, that period ending just 2 weeks before we met. SINCE we met, she's had to hit the ER a number of times, sometimes with broken bones (osteoporosis, very slender bones, and poor balance--thank you Actonel for it being better lately). Sometimes the ER was very helpful.

But not always, and when they weren't, the problem was this:

THEY WOULD NOT LISTEN. We went in one time (not in AZ where we now live) because her bladder had prolapsed, she was about to give birth to the thing. The MD on duty took the longest time figuring out the problem NOT because he was incompetent but because he ASSUMED she was asking for pain meds.

It didn't matter that she told him otherwise. It didn't matter that I told him otherwise. Oh, he FINALLY got it, but the trauma (for Pam) of being once more ASSUMED to be an addict was and is very hard for her.

Of course, down here we don't have that problem. Every doctor we've approached has simply refused to take her on as a patient, so she's been cold turkeyed of ALL of her meds (14 in total, 5 that a life-critical) for nearly 3 months now.

And don't get me started on Psych hospitals. I put her in, one time, because she was suicidal. She was suicidal because the phenytoin she'd been on for years (for petit mal seizures) had finally begun to accumulate in her liver; she was incredibly toxic.

Once her liver had a chance to clean out, she was fine--but the shrink would not release her until she accepted being put on Neurontin and Zyprexa. When I read the pharmacology sheets on those two, the "rare but potentially deadly" side effects were incredible--and she was already experiencing symptoms of 35 of them!!

She and I (despite the risk there was no real option) cold turkeyed her off both, and I (with Pam's help) wrote said psycho-quack informing him that from now on in our book, his name was Dr. Kevorkian. There's a HUGE red flag on her file to this day in Helena, Montana.

Um...guess it's pretty clear Pam and I are more or less just plain disgusted with the medical field in general, with or without including the psych side.

dianado on July 26, 2008:

great article - Thanks to hightened awareness and people bringing the topic to attention, I think the problem can continue to lesson of staff being ignorant of mental illness treatment and response methods. I'm glad you highlighted this.

Boo McCourt from Washington MI on July 26, 2008:

What really concerns me is the lack of knowledge the ER's have and the lack of compassion. I am bipolar and remember going into an ER room a few ago bleeding with cuts all over my arms and complaining of voices. I had called every person I had known that the voices were telling me to do things. The ER said I didn't need to be admitted. The next day I overdosed, was arrested, and committed to a mental hospital for 3 months. I can't tell you how embarrased I felt when they turned me away. I needed help and I knew it.

I ended up in another city altogether. They could not believe or understand why I was not admitted. So I believe it depends on the hospital and what they are taught. or perhaps they just think your faking or don't have a bed. I don't know. But it is a shame that people fake a mental illness to get a bed. I like your hub. It is very well written. I think the answer is more awareness, more teaching, and more hands on. A little bit more compassion wouldn't be a bad idea either. I do know many things need to change though.

Thumbs up.

Annette Thomas (author) from United States on July 25, 2008:

You're welcome. It's a subject that needs to be addressed.

St.James from Lurking Around Florida on July 25, 2008:

Great Post!

Thank you for bringing this topic to the for-front

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