COVID-19 leads to increase in psychiatric cases in NJ

Credit: newbridgehealth.org

Hospitals and emergency care clinics around New Jersey are caring for a growing number of patients with acute anxiety, drug overdoses, suicidal ideation and other psychiatric crises, a trend according to experts who is largely due to the current COVID-19 pandemic. Many of the patients are children.

Bergen New Bridge Medical Center, which has the state’s largest inpatient psychiatric program, is busier than it has been for more than a decade, officials said. The hospital’s 17-bed pediatric program is also crowded most weeks.

“Over the past few months, this unit has been filled to capacity most of the time,” Deb Visconi, president and CEO of New Bridge, told NJ Spotlight News. “And that’s not surprising, when you think about what has happened in our society over the past year and a half, especially to children.”

COVID-19 has killed more than 27,000 New Jerseyans and left more than 90,000 hospitalized since it first appeared in March 2020. The result: significant grief and trauma – especially among black and Hispanic residents, for whom the rate of mortality was at least double that of whites. It has also resulted in widespread economic losses, as the state has processed more than 2 million jobless claims so far, as well as anxiety and isolation as schools, businesses and public spaces have been closed for months to reduce viral spread.

Public health and pandemic

“I am concerned about the public health consequences of the pandemic,” said Dr Shereef Elnahal, president and CEO of University Hospital in Newark, a city hard hit by the coronavirus. His concerns include the “long COVID” – a medical condition with symptoms ranging from brain fog to severe organ damage – and racial disparities in health outcomes, which have a huge impact on a majority-minority city like Newark.

“I am also very concerned about the mental and behavioral health morbidity that is going to come – it’s already there,” said Elnahal, a former state health commissioner. Among Newark residents, the need has grown dramatically over the past year, he said last week, speaking during a round tableon COVID-19 and Healthcare hosted by New Jersey Policy Perspective.

The University Hospital’s behavioral health unit is often at full capacity and emergencies frequently see patients with suicidal thoughts or who pose a danger to others, Elnahal said, situations that require additional safety and attention. specialized treatment, including inpatient care. To help meet this need, the University formalized an agreement with New Bridge to make it easier for the Bergen County Hospital to accept psychiatric patients from the Newark emergency room.

“It will help them offload themselves (psychiatric emergency patients with severe needs) and really put those patients in the best place, where they will get the best care,” said Visconi. New Bridge has informal agreements with other hospitals to accept psychiatric patients who are beyond their facility’s scope of care, she said, but the formal agreement with the University will further facilitate the transfer process.

Treat urgent cases

With New Bridge’s behavioral health units busy, Visconi said the Bergen County-owned facility – New Jersey’s largest acute care hospital, with more than 1,000 beds and dozens of programs to treat diseases throughout the body – continues to have capacity. New Bridge is affiliated with Rutgers New Jersey Medical School, which shares a Newark campus with the University Hospital, and some of the state’s most respected behavioral health systems, making it the best clinically equipped to cope to these urgent cases, Elnahal said.

The need isn’t limited to New Jersey, of course. Research by the nonprofit Kaiser Family Foundation found that more than 30% of adults nationwide reported experiencing anxiety or depression during the pandemic, nearly three times the rate reported in 2019 . In New Jersey, nearly 28% of adults said they had suffered from these problems this spring, up from 16.4% before the pandemic, KFF found.

OD deaths are increasing

State data indicates that New Jersey also saw a record number of overdose death during the first half of 2021 and could see 6% more deaths than in 2020, if the current trend continues. It comes after the number of fatal overdoses first declined from 2018 to 2019, the first drop after nearly a decade of steady increases.

For some people in crisis, emergencies are the best option. An analysis of emergency room diagnoses conducted by the New Jersey Hospital Association found that while emergency room visits declined overall in the last nine months of 2020 – when the pandemic was in full swing – the proportion of anxiety diagnoses increased by 19% and diagnoses of substance use The disorder increased by almost 30% compared to all other diagnoses. The proportional increase was even greater in children, according to the NJHA.

The problem appears to be getting worse as the pandemic continues this year, which Visconi and Elnahal said they saw at their facilities. Emergency room visits involving behavioral health diagnoses – as a primary or secondary concern – increased by almost a third from the second quarter of 2020 compared to the same period this year, according to additional data analysis by the NJHA, and inpatient admissions for behavioral health patients increased by 21%

“Our hospitals and ambulatory care providers continue to face the demands of an increased volume of behavioral health cases, as well as increasing patient acuity levels – individuals need more intensive services, have more complex conditions and often require medical interventions, ”Mary Ditri, the vice president of community health for the NJHA said in an email. “System flexibility is important to meet these dynamic needs. “

Most behavioral health services in New Jersey and across the country are provided through community programs and outpatient services, which experts have generally said is more appropriate. But as more psychiatric patients show up in emergency rooms, some hospital leaders believe it’s time to increase inpatient capacity – a big change in the world. trend for decades towards deinstitutionalization.

“Before this pandemic, I would have been the last person to say that we need more mental health and behavioral health capacity for hospital patients. The name of the game was to transfer more of this care into the community, as a best practice, ”Elnahal said. “But we are seeing so many people in acute crisis now,” he said, people “who require hospitalization and we are facing real limits in the ability of hospital patients to deal with this very serious acute mental illness” .

The state operates four residential mental hospitals, housing about 1,300 people, with additional behavioral health beds available at county-run and private facilities. New Bridge, where the average behavioral health stay is eight to 10 days, has more than 300 beds in the psychiatric unit and more than 50 in a medical detox unit.

The state Department of Health, which licenses the hospitals, did not respond to questions about the total number of New Jersey psychiatric beds, current capacity and plans for expansion. Former Governor Chris Christie, who focused on expanding addiction services at the end of his second term, urged DOH to “call” on hospitals to create another 900 psychiatric beds, a demand that was later reduced to 864. The DOH also declined to provide an update on this process.

“This will require a panoply of policy solutions,” Elnahal said, including additional investments in community services and better integration with other medical care. “But above all an increase in the capacity for short-term hospitalization,” he continued. “But we also need to plan as a region and as a state for the real acute mental and psychiatric needs that we are about to see go further and further in the wrong direction.”