South Dakota Hospital Tells Psychotic Patients: Go Directly To Jail. Not Welcomed Here!

rapid city

(2-13-17) Officials at Rapid City Regional Hospital in South Dakota need to re-read the Hippocratic Oath and ask themselves if they are proud of how they are treating individuals with mental illnesses in the Black Hills region.

Unless someone in a mental health crisis also has an “acute medical need,” the hospital is turning them over to the police to be held in jail for 24 hours even though they have not committed any crimes.

A hospital spokesman explained that psychotic individuals often are disruptive and frighten other patients so they are not welcomed at the hospital. South Dakota allows law enforcement to temporarily detain individuals in jail up to 24 hours without charging them with a crime.

Rapid City Police Chief Karl Jegeris criticized the hospital, according to Mike Anderson, a reporter with The Rapid City Journal, who disclosed the hospital’s new policy.

“This is the biggest step backward our community has experienced in terms of health care for mental health patients. And though it’s legally permissible by statute to put someone in an incarceration setting, it doesn’t mean that it’s the right thing to do.”

The Rapid City hospital is not the first to turn away pesky psychotic individuals. Consider the angry call that I received in Fairfax County, Virginia, where I live, from an outraged parent who said a local ER here called the police and had her son arrested for trespassing after he showed up seeking psychiatric help.

The term “streeting” was coined by emergency room workers in the Hampton Roads area of Virginia for patients who were clearly ill but were turned away without receiving any psychiatric treatment. An inspector general report found that 200 had been “streeted” by hospitals in the Hampton Roads area during a one year period rather than helped.  Virginia took steps to stop this practice after state Sen. Creigh Deeds couldn’t find a bed for his son, Gus, who later attacked him before ending his own life.

There are reasons why hospitals don’t want to admit psychotic patients. Many of the sickest don’t have insurance, they are difficult to help, and oftentimes they can be disruptive, uncooperative and violent.

But the biggest reason is a national shortage of treatment beds. As I have traveled the country giving speeches, I have heard numerous complaints about “psychiatric boarding” – holding individuals in emergency rooms while they wait for a hospital bed. Recently, I was in a North Carolina community where I was told that it could take up to three days for a bed to be available.

So why is it so tough to find a crisis care bed?

They are expensive and often cost hospitals more than they bring in. Officials must balance money losing beds with beds that are profitable. We also have pushed for more community treatment, rather than hospitalization.

Last week, the Treatment Advocacy Center released a troubling study that focused on bed shortages for individuals who are in the criminal justice system.

After climbing to a peak of 337 beds per 100,000 persons in 1955, the movement to “deinstitutionalize” mental illness drove the state hospital bed population to 11.7 per 100,000 by early 2016.

Although community and private hospitals expand the total universe of inpatient options for psychiatric patients somewhat, their beds are largely occupied by insured patients who have voluntarily sought care.

Patients referred by the criminal justice system typically are not eligible to use them. The most widely recognized direct result of bed shortages is the virtually universal phenomenon known as “boarding” — the practice of holding psychiatric patients for extended periods in hospital emergency departments (ED) until beds become available.

Bed waits by mentally ill detainees in jails are the forensic equivalent, and they are nearly as widespread. State hospitals dedicate an increasing percentage of their beds to the inmate population, but demand outstrips supply. As a result, the majority of state hospitals maintain bed-wait lists of inmates who have been court-ordered or otherwise referred for incompetent to stand trial (IST) services. In most states, these waits are around 30 days, but three states have reported forensic bed waits of six months to a year.

Having someone in the midst of a mental health crisis sit in a jail cell is a recipe for disaster and results in more and more pressure on jails and prisons to become mental health facilities. This is wrong. You shouldn’t have to go to jail to get mental health help.

In addition to releasing its grim report, the Treatment Advocacy Center released a mathematic model that provides a roadmap for communities to cut wait times. See Emptying the New Asylums. 

Fortunately, there are communities where hospitals, law enforcement, and mental health providers have found innovative ways to stop “streeting” and “psychiatric boarding” whether it is happening in emergency rooms or local jails. Leon Evans and Gilbert Gonzales in Bexar County, Texas, have created the gold standard for jail diversion and community treatment.

My parents spent nearly three decades living in Spearfish, South Dakota, which is 45 minutes north of Rapid City, and I have been to the Rapid City Regional Hospital. The people who live in this area are good, hard working, honest folks who care about each other and quality medical care.

It’s unfortunate, that the hospital’s leadership has not reached out for help from folks such as Leon or Gilbert, and the community’s elected leaders have not sought a solution other than sending someone who is sick to jail. Their attitude sends families a clear message: the life of your loved one is not worth as much as someone with a broken leg or having a heart attack. You are on your own, don’t bother us.

I wonder if Dr.  Gregory L  Smith, M.D. who is listed as the  Chief of The Medical Staff and Director of Rapid City Regional Hospital, Inc. had a son with a serious mental illness if he would accept his hospital’s new policy of calling the police when someone knocks on the door in a crisis?

My friend and fellow blogger, Dr. Dinah Miller tipped me off about the Rapid City Hospital. You can read her take here.




About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.