Between the pings of the monitoring equipment and the general hum of activity in the emergency room at the Melrose-Wakefield Hospital, bits of conversation between the staff drift in and out across the nurses' desk.
At the beginning of the evening shift, nurses are monitoring the behavior of two of the patients. One is suicidal. One has had too much to drink. A security guard watches over them. Right now, the patients are calm, and they do not disturb the rhythm of the ER.
Nurse Sue Croft is headed home. "Too bad you weren't here earlier," Croft says. "When we had a lot of psychiatric out-of-control people. Like this morning, during our staff meeting, at 6:45 this morning, there was angry outbursts. A patient that didn't like men. So that was a problem, since the security guys are all men."
In recent months, the emergency room has seen an increase in these kinds of incidents.
"Over the last six months — maybe eight months — we've noticed that there's an increased number of people coming to the emergency department with behavioral health issues," says Stephen Sbardella, chairman of emergency medicine at the Melrose-Wakefield Hospital and Lawrence Memorial Hospital in Medford.
As budgets for both outpatient programs that keep the mentally ill living on their own and hospital beds for the seriously mentally ill have been cut, Sbardella says patients end up at the ER. "So the emergency department becomes the safety net for a lot of people," he says.
The staff sees more patients with depression, and also a younger population.
"They're not necessarily more violent, but they're more clinically complicated," says Mark Mahnfeldt, the director of emergency services at the hospital. "So patients are spending a lot more time in our emergency departments. So it's been more of challenge to the staff overall. We've had to increase their training for de-escalation measures, as well as the security staff."
The Massachusetts College of Emergency Physicians says its members are not reporting an increase in violence since these recent budget cuts. But emergency room nurses say they have seen an increase in disturbances since the state first began cutting the budget for mental health and substance abuse programs last year.
Julie Pinkham is the executive director of the Massachusetts Nurses' Association. "Escalating verbal behavior, unruly behavior, physical assaults — all on the rise," she says.
The emergency room staff at the Melrose-Wakefield Hospital handles most situations without the need for outside assistance, but there are those occasions when they need extra help. So the increase in psychiatric patients at the ER's door is putting a strain on the city's police budget.
Police Chief Michael Lyle says his officers are making frequent visits to the emergency room to calm down disturbances. "We're taxed pretty well because of our local hospital," Lyle says. "With all the hospitals closing around us, Melrose-Wakefield Hospital gets overwhelmed with emergencies. A lot of people use that as their primary-care physician, too, so they get overwhelmed in the emergency room. They get antsy, and the police wind up responding. On certain weekends, we send our whole shift up there to quell disturbances."
The police chief says this happens often. "Uh, pretty much every weekend," Lyle says.
Neither Lyle nor the hospital could provide any statistics on how often the police is called to the ER. But the emergency room visits are definitely a source of frustration for Mayor Rob Dolan.
"In a city that only has three police officers on the street, when you get a call that says we have a violent, possibly mentally ill or narcotics threatening staff, I need to send all three to the hospital," Dolan says. "Therefore, I have zero, zero staff on the streets."
The doctors and nurses in this emergency room and the police officers who are called in are feeling firsthand how state budget cuts in one area — mental health and substance abuse programs — can put a strain on emergency services and public safety.
This program aired on July 2, 2009.