Spokane-area mental health practitioners say they've seen a noticeable increase over the last several years in the number of crisis-level psychiatric patients who are seeking immediate care at hospital emergency rooms and other crisis-response centers.

While this trend is being influenced by many factors, those local specialists say the stagnant economy as well as state and federal funding cutbacks to mental health care resources are key driving forces behind it.

Many psychiatric patients who are showing up in emergency rooms suffer from chronic conditions, but there's also been an increase in the number of patients who may never before experienced any symptoms of a psychiatric disorder, which likely is an indirect result of the nation's poor economy, they say.

"Unfortunately, with the economic times now, people are losing homes and jobs, and marriages are suffering and they come to the ER" for help with psychiatric issues triggered by those events, says Dr. Saj Ravasia, medical director of psychiatry services at Providence Sacred Heart Medical Center & Children's Hospital.

Ravasia says that in addition to the mental stressors caused by the economic situation, state funding cuts to programs that provide mental health-care services has led to more people coming to the emergency room for psychiatric-related issues.

"With more limited resources in the community, patients who are chronically ill are decompensating because they don't have the same level of support," Ravasia says. "Those with the first (signs) of an illness often can't be seen by someone else in the community right away, and so then they come to the ER."

In psychiatry and psychology, decompensation refers to a patient's inability to respond to or cope with psychological stressors.

Crisis-level psychiatric conditions include such behaviors as a patient who's actively suicidal, is mentally unstable as a result of substance abuse, or is showing signs of acute psychosis, Ravasia says.

Acute psychosis includes symptoms or behaviors such as hallucinations, delusions, paranoia, disorganized thinking, and any other changes in a person's baseline—or normal—responses to their environment, he says.

People with psychiatric disorders who are using drugs or alcohol also often end up in the emergency department as a result of the psychotic symptoms those substances can trigger, he says.

Ravasia adds that the six physicians in Sacred Heart's department of psychiatry, including him, are seeing between five and seven actively suicidal patients each day.

As a large portion of the population continues to age, Ravasia says there's also been an increase in psychiatric conditions in senior citizens. He says that as the aged population becomes less capable of tolerating stressful life events, they are at a higher risk of experiencing a psychiatric episode that might require immediate medical attention.

Jan Dobbs, director of crisis-response services at Spokane Mental Health, the nonprofit agency located at 107 S. Division that provides a wide range of mental-health services, says another factor that may be influencing the increase in psychiatric patients seeking care in an emergency room setting is a lack of knowledge as to the other mental health resources available in the community.

"They may not know that we have a 24-hour crisis line, and volunteers can talk to them and help them locate resources," Dobbs says. "If they need clinical assistance, they can get a clinician on the phone. Some people go to the ER because they don't know what is out there or how to find it."

On July 1 of this year Spokane Mental Health and Family Service Spokane merged to form Frontier Behavioral Health, although both of those agencies for now have continued to retain their respective names as operating divisions of Frontier.

Dobbs says Spokane Mental Health's crisis-response professionals will respond to patients in any setting, including hospital emergency departments or in a person's home. She says that when the agency responds to such cases, the patient's condition is assessed first to determine how to stabilize him or her.

"Together, the clinician and support staff may work with that person to help them find resources and follow up with them to make sure they are stable and their risk hasn't increased," she says. "If someone is really at risk—someone who is suicidal or homicidal and can't care for their basic needs—we may assist them in voluntary admission at a (psychiatric) treatment facility."

Another trend is that many people who are using Spokane Mental Health's crisis-response services appear to be sicker and are suffering from a wider range of psychiatric symptoms, Dobbs says. She's also noticed that the agency is seeing a higher number of new patients than it typically does.

"There is always a number of people we see that have a chronic illness, but anymore, we're seeing people who we've never had contact with before, and that is something that's different," she says.

Dobbs says she's been looking into that trend for several months now and is trying to pinpoint where those new clients to Spokane Mental Health formerly had been receiving treatment, and why they aren't receiving care from that provider anymore.

She says that the agency also is seeing more patients without any form of medical insurance, which she says is a sign of the economy and job loss. She adds that the taxpayer-supported agency doesn't refuse care to any patients, regardless of their ability to pay for its services.

Sacred Heart's Ravasia says that while he's not sure of the exact increase in the number of psychiatric patients who are coming to Sacred Heart's emergency room for immediate medical attention, he estimates that the prevalence of those cases grew between 5 percent and 7 percent just in the last six months.

"There has been a consistent increase over the last five years, and in the last 18 months to two years, it's been markedly so," Ravasia says. "Following the legislative cuts in the spring, we have seen it even more so and have been full in our adult (psychiatric) unit almost consistently in the last six months."

The state Legislature cut funding for mental health-related programs by more than $8 million each year during the 2011-2013 biennium, says John Wiley, a Spokane-based spokesman for the Washington state Department of Social and Health Services. Included in that amount was a $375,000 reduction in funding for programs in Spokane County, Wiley says.

Wiley says that while those cuts may seem significant, the Legislature allocated $1.1 billion in state funds for community mental health programs.

In addition to the increase in psychiatric patients seeking crisis-response care at Sacred Heart, one of two hospitals in the Inland Northwest that has a psychiatric unit, there are between eight and 10 patients on any given day who are waiting for a bed in its psych unit, Ravasia says.

Sacred Heart has 46 adult beds and 24 adolescent beds in that unit, he says.

Ravasia says that while the length of stay at Sacred Heart's psychiatric unit depends on a patient's needs, the average length of stay is 7 1/2 days. The minimum stay length for a psychiatric patient at the hospital is 24 hours after admittance to allow for an evaluation, he says. The longest amount of time a patient could stay in the hospital's psych unit is two weeks, and if patients aren't stabilized at the end of that time, they're transferred to Eastern State Hospital, the state-funded psychiatric hospital in Medical Lake, he says.

While Spokane's second largest hospital network that includes Deaconess Medical Center and Valley Hospital & Medical Center doesn't have a psychiatric unit, one other Inland Northwest hospital that does is Coeur d'Alene's Kootenai Medical Center.

Julie Holland, a spokeswoman for Deaconess, says that any psychiatric patients who come into Deaconess's emergency department and need inpatient treatment are transferred to Sacred Heart's psychiatric unit.

Eastern State Hospital serves as a long-term care facility for patients who mostly are involuntarily referred there through a court order, Wiley says. He says that because Eastern State is generally where some psychiatric patients end up after being evaluated for their treatment needs, it doesn't see any crisis-level cases.

Psychiatric patients that don't require long-term hospitalization at Eastern State and might be able to re-enter the community after being treated typically are transferred to one of several short-term mental health facilities here, says Ravasia.

One of those facilities is Spokane Mental Health's Foothills Evaluation & Treatment Facility, an inpatient care center at 505 E. North Foothills Drive that provides stabilization services to psychiatric patients who are a risk to themselves or others.

The 16-bed facility is licensed and certified by the state as an evaluation and treatment program and a residential psychiatric treatment facility, says David Panken, CEO of Frontier Behavioral Health.

Patients who are admitted to Foothills involuntarily could stay between a minimum of 72 hours and a maximum of 14 days. If needed, an extension can be requested of the state to keep a patient there for a total of 30 days, Panken says. Clients who voluntarily admit themselves to Foothills can stay there for less than 72 hours, or as long as it takes them to stabilize, he says.

Hartson House, at 904 E. Hartson, is Spokane Mental Health's other residential treatment facility, and provides stabilization services to a person who voluntarily seeks care there to allow them to re-enter the community typically sooner than a patient receiving treatment at Foothills, Panken says.

He says that facility, however, will close later this fall when Spokane Mental Health opens its new inpatient psychiatric facility called the Calispel Evaluation & Treatment Facility, at 1401 N. Calispel. A $3.9 million project to renovate and add to an existing two-story building there for that facility is expected to be complete sometime this fall. The new treatment center will have 16 beds, which will include the seven beds at Hartson House that will move there as well as nine new beds, Panken says.

Crisis triage services also are available through Spokane Mental Health. That outpatient program assists individuals who are experiencing serious mental health or emotional crises and whose issues can be addressed and resolved to allow them to return to community in a stable condition within 24 hours or less, Panken says.

Ravasia says Sacred Heart's psychiatric team often refers its patients who come into the emergency room to those crisis triage services.

In addition to the psychiatric services Ravasia and his team of physicians provide to patients in the hospital's psych unit, he says they also see patients who are in the hospital for other procedures and also might have psychiatric care needs.