Research: Care in ER settings difficult for mental health, substance abuse patients, providers

By Danielle Ray
April 3rd, 2023
Linda Isbell, Ph.D., is the Feldman-Vorwerk Family Professor in Social Psychology at the University of Massachusetts Amherst’s department of psychological and brain sciences.
Linda Isbell, Ph.D., is the Feldman-Vorwerk Family Professor in Social Psychology at the University of Massachusetts Amherst’s department of psychological and brain sciences.

Two professors are part of an effort to shine a light on the challenges of providing mental health and substance abuse care for patients in emergency department (ED) settings.
According to published reports, one in eight visits to the ED across the country involve psychiatric or substance use concerns — and the frequency of such visits continues to rise.

Research published in January in the “Annals of Emergency Medicine” revealed that Linda Isbell, Ph.D, and her colleagues developed a comprehensive, data-driven model of the challenges and care dynamics associated with providing ED care to patients with mental health and substance use disorders based on in-depth interviews with 86 ED physicians and nurses working in eight hospitals in the Northeast U.S.

Isbell is the Feldman-Vorwerk Family Professor in Social Psychology at the University of Massachusetts Amherst’s department of psychological and brain sciences.

“The results we reported in this ‘Annals’ paper come from a larger study investigating emotions in emergency medicine, specifically, emotional experiences of emergency physicians and nurses,” Isbell stated.

The data focused on a large subset of patients frequently seen in emergency departments—those with mental illness and/or substance use issues.

“I care very deeply about these populations, which are ignored all too often by so many in our society, and I have a strong desire to find ways to improve their healthcare experiences and overall wellbeing.” -- Linda Isbell, Ph.D, Feldman-Vorwerk Family Professor in Social Psychology, University of Massachusetts Amherst

“These populations present some unique challenges to healthcare providers and our goal was to identify and document those challenges (that are) at multiple levels — emotional, diagnostic, and logistical,” she said.

“We found that these challenges can contribute to negative attitudes and expectations toward these patient populations and can lead to adverse consequences for both patients and healthcare providers,” Isbell noted.

She said the results make clear that major changes and interventions are needed at the institutional level and at the level of public policy to improve healthcare for these populations as well as provider wellbeing.

Isbell has been at UMass since 1999 and said that since her days as an undergraduate student, she has been interested in “understanding how emotions influence information processing in real-world contexts, including during impression formation of political candidates, job applicants, ordinary people, stereotyped others, and the self.”

She said the strong negative emotions and significant stigma that exist toward individuals with mental illnesses and/or substance use disorders were a “natural extension,” of her more than two decades of research to explore how these emotions may impact the healthcare that these vulnerable patient populations receive.”

“I care very deeply about these populations, which are ignored all too often by so many in our society, and I have a strong desire to find ways to improve their healthcare experiences and overall wellbeing,” Isbell said.

Isbell and the team of researchers, including Edwin Boudreaux, professor of emergency medicine, psychiatry, and quantitative health sciences at UMass Chan Medical School in Worcester, developed the model that emerged from their data and findings. It gives a visual of the cycle of care that can adversely affect both the patient and health care provider.

In their research, they describe logistical, interpersonal, and systems barriers that make it difficult and sometimes impossible to properly diagnose and treat ED patients with substance use disorders and psychiatric conditions.

Isbell said she is deeply concerned about the healthcare disparities that individuals with these issues experience and is committed to developing understanding of these disparities and what might contribute to them.

She hopes this understanding can open to new avenues for change in the form of interventions, public policy changes, etc.

“Given that so many individuals with these conditions seek care in emergency departments, it seemed like an important context in which to understand the challenges that this care context presents both for patients and for healthcare providers,” Isbell said.

She stated that the ED “is a high-risk practice environment by its nature” and that “additional efforts can and should be made to reduce this risk.”

“We must support our healthcare providers and provide them with more resources so they can do their jobs effectively,” Isbell stressed. “It is critical that our healthcare providers not be blamed for the failures of our healthcare system.”

Edwin Boudreaux

Edwin Boudreaux, professor of emergency medicine, psychiatry, and quantitative health sciences at UMass Chan Medical School in Worcester.

Boudreaux, who has been at the medical school since 2009, said he has “always been intrigued by the complexity and beauty of human psychology, including interplay between environment, learning, emotions, behaviors, biology, culture, and spirituality.”

When asked what his top takeaways are from their research, Boudreaux said, “providing high-quality of care for psychiatric patients is incredibly challenging and influenced by many factors, ranging from clinician perspectives to system resource inadequacy to the patient’s own behaviors.”

Noting that psychiatric emergencies can be enormously stressful events for the patient, their families, and the providers who care for them, he said, “When people experience these emergencies, our system of care can either serve them well in their most vulnerable time, or serve them poorly, even making them worse rather than better.

Understanding the dynamic between the perspectives of clinicians who care for patients experiencing psychiatric emergencies, the quality of the care they receive, and their outcomes is really important to helping make sure we are providing the best care possible.”

Isbell said that as a social psychologist, not a clinical psychologist or emergency healthcare provider, the findings of their research did surprise her “to some extent.”

Although she was aware of the challenges in the healthcare systems and disparities among certain populations who seek care in different clinical settings, Isbell said it was surprising to learn of the extent of the challenges in the ED.

“It seems things truly are approaching or at a breaking point. Change is badly needed to ensure these vulnerable patient populations who desperately need care receive it and to support and protect our ED providers who are often stretched way too thin,” she said.

Boudreaux said they are planning future research and studies “to dive deeper into understanding how stigma impacts medical decision making and devising ways we might improve such decision making through interventions targeting clinicians and systems of care.”

One Response to Research: Care in ER settings difficult for mental health, substance abuse patients, providers

  • April 5th, 2023 at 8:38 pm Geraldine Casey posted:

    The burden of managing a mentally deranged patient happens at an alarming rate in every Australian public ED. The substance abuse patient is far more destructive to Staff and other patients than the mentally unwell person who has not used a drug. In the Western Australian Mid West City of Geraldton the police attend EDs 24/7. This is not the police responsibility. In fact it behoves Police to remove the drugs from the streets. However, Australian Drug Policy has disempowered the Police in every way by allowing the removal of drug laws which has caused our 30 year drug addiction tsunami with extraordinary numbers of addict’s babies born addicted in utero. Drug addiction causes acute child development delay, most often the addict abandons the child at birth and from this time the child’s life trajectory is doomed as an outsider in community with serious brain disorders. These are the young teens, and getting younger,, who end up in youth detention after breaking the law on multiple times. These children are either appointed Public Guardianship or left to the care if their Grandparents or extended families. The only solution to stop this horrendous damaged Society is Education to Prevent Drugs in the first Instance instead of the last 30 years of the Public Health and Law Enforcement enshrinement of Harm Reduction)turning a blind eye to drug users i.e Minimising the destruction of life by every drug addict – with not one exception 😥😥

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