But, he added, the city needs more psychiatrists to work with the homeless on the streets between hospitalizations. “You can get people to a certain point of well-being and stability while they’re in the hospital, but the real thing is outpatient — getting services to people where they need it.”
For some people with severe mental illness, hospitalization can pave the way for years of stability after a psychotic episode. But others cycle between the hospital and the street. Homelessness – with its stress and danger – increases the likelihood of another psychotic episode followed by another hospitalization.
“It doesn’t make sense to take people who are homeless and just put that person back on the street,” says Dr. Mitch Katz, the president of the city’s public hospital system, which operates some of New York City’s largest psychiatric units. “All that’s going to happen is they’re going to be subjected to the same stress of life on the street, medications are going to be lost, they’re going to miss their appointments, and they’re going to relapse into psychosis and at some point. point they are returned to the psychiatric emergency room where the process will begin again.
Already every day, homeless people end up in the city’s emergency room, brought in by police and paramedics after their behavior has crossed a line. Sometimes this process begins with a 911 call. Or it may begin when a shelter director learns that a resident, gripped by paranoid delusions, began arguing with other shelter residents.
Some large hospitals have a separate psychiatric emergency room where patients are held for several days for observation. At Columbia, for example, there can be about 30 patients at a time, most of whom stay for three to five days.
Here, psychiatrists evaluate those who need longer hospitalization in a psychiatric ward. Patients whose psychotic episode was triggered by drugs, such as the inexpensive synthetic cannabinoid K2, often seem brighter after a day or two and are discharged. Others are also soon deemed fit enough to be released. “Sometimes someone looks and sounds completely different 16 hours later, after being in our psychiatric emergency room,” said Dr. Katz, after which they were fired.
But for many patients with unattended schizophrenia, psychiatrists are trying to find a bed in an inpatient psychiatric ward. That can mean a lot of phone calls and rejections.