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House of Representatives
Session of 2019 - 2020 Regular Session


Posted: April 2, 2019 11:49 AM
From: Representative James B. Struzzi, II
To: All House members
Subject: Understanding the Commonwealth’s Treatment Capacity to Address Community Needs
It is imperative, as Pennsylvania faces an historical crisis in mental and behavioral healthcare, that we understand the Commonwealth’s treatment capacity to help strategically address the needs of our communities.

In 2016, approximately 18.3 percent of U.S. adults reported mental, behavioral, or emotional disorders. Nationally, spending on behavioral health treatments accounted for $109.6 billion dollars in 2015 and, according to an article in the “Emergency Medicine International”, the “average patient with psychiatric service needs directly costs an emergency department (ED) $1,198 - $2,264 per visit, with many presenting at the ED multiple times throughout the year”.

A shortage in mental health professionals and lack of access to timely treatment services, positions EDs as a de facto safety net for psychiatric treatment. And while many EDs are improving their ability to effectively assess and triage patients in need of psychiatric care, hospitals often face long delays in dispositioning patients to appropriate inpatient and outpatient treatment settings. Delayed disposition of psychiatric patients impacts both patients and delivery system outcomes—increasing psychological stress on patients, delaying mental health treatment that could mitigate the need for a mental health inpatient stay, consuming scarce ED resources, worsening ED crowding and delaying treatment for other ED patients.

The true, systematic barriers to timely placement and access to appropriate behavioral health services are not fully understood. Anecdotally, we hear that delayed discharges are often due to a lack of inpatient beds, gaps in levels of care (non-hospital, residential care), insurance design and prior authorization requirements, transportation gaps and patient complexity (co-occurring diagnosis, pregnancy…). However, there’s no true data source to help us understand the issue at a systemic level—not statewide data source record ED wait times for patients seeking psychiatric care or information on the cause of delays.

To begin to understand the full picture of the commonwealth’s treatment capacity, I am proposing a resolution directing the Joint State Government Commission to study:
  • the patient care impact of delayed emergency departments discharge of patients with behavioral health diagnosis
  • the impact emergency department operations and financial impact of delayed emergency departments discharge of patients with behavioral health diagnosis;
  • the cause of delayed emergency departments discharge of patients with behavioral health diagnosis and why these delays oftentimes last longer than timely care calls for

By starting with studying a specific element of treatment pathway I hope, we as policymakers, can begin to truly understand the complexity of a system we do not yet comprehend. Please help us move toward solving this growing crisis – and save lives - by co-sponsoring this important resolution.

Introduced as HR268