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Wed Apr 18 13:01:54 BST 2007

I admire and support Dr. Mattox' "Root Causes" thread; but frankly, I
fear that dissecting the social cellulitis of mental and behavioral
health in America will be a mostly empty exercise, at least for the
Trauma-List.

Could we instead -- or at least in addition -- talk a little about the
Virginia trauma system?  What little I've heard via the media suggests
high function at every level, and I'd like to know more about it.  What
are the local resources; what is the architecture of the system; how was
it triggered; was the intra-system communication preplanned or ad lib;
ditto the prehospital transport system...

Don't get me wrong: I'm deeply interested in public policy and believe
that Ken's motivations are honorable.  In most other circumstances I'd
probably be joining in the prevention discussion.  But I work about
eight miles from a major university, and have spent the last couple of
days considering how Virginia's nightmare could have easily taken place
in Maine.  I'm hopeful that we would have responded as capably; but if
there's anything we all might learn from, I want to get started.

Pret Bjorn, RN
EMMC Trauma Program
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com
Sent: Tuesday, April 17, 2007 4:48 PM
To: dbthemedic at hotmail.com; med-events at ccm-l.org
Cc: trauma-list at trauma.org
Subject: Root Causes

Although I should use my allocated bandwidth time to talk about trauma
and  
to compliment those who have done a good job in Virginia's trauma
response, I  
want to talk about a totally different subject which has consumed
increasingly 
 more and more of my administrative time.   

The subject is Mental & Behavoral Health.    

Since the closure of state mental health and psychiatric hospitals,
there  
has been an increasing effort to push the responsibility for
identification and  
treatment more to the local level.  That is perhaps as it should be, but

funding has been sparse to negligible.   Hardly a family, and many of
our 
colleagues are affected by depression, and other mental health
diagnoses.   
Treatment is sporadic and expensive.   

Add a mental health problem as a co morbid factor to diabetes, heart
attack, 
pneumonia, trauma, etc, and we have a really big  problem.    

Houston is the 4th largest city in the US.   It has a fast growth  rate.

In 2000, 3000 inpatient psychiatry beds  existed.   In 2007 there are
700, 
despite an almost doubling of the  population in those 7 years.   One
public 
psychiatric hospital (HCPC)  has more than 300 built beds, but less than
90 are 
staffed and there are no iv  fluids, no syringes, no IM medications in
this 
hospital.  ANY , ANY co  morbid condition results in an attempted
transfer out 
instantaneously to BTGH  were there is tight overcrowding of mental
health 
conditions.   Up to  37% of the admissions to medicine and surgery,
including trauma, 
have a mental  health component.   

We have 20 in hospital mental health beds, 12 Emergency Center closed
beds,  
and up to 12 close observation sites in the emergency center proper.
We 
have at any time more than 20-40 inpatients on the surgery or medical
wards  who 
have both medical and mental health problems, often the mental health  
problems are severe.      If we tripled the number of  in-hospital
mental health 
beds, they would be filled in 12  hours.    

Now back to the subject that prompted this post.   I suspect  that much
of 
the violence, wild use of firearms, and other human/social  outbursts
may have a 
mental health overtone, an untreated or undertreated  condition.    

Finally:

IF THE MENTAL HEALTH CRISIS IN HOUSTON, IN TEXAS, IN THE UNITED STATES
IS  
NOT ADDRESSED SYSTEMATICALLY, MORE HUMAN OUTBURSTS ARE GOING TO  HAPPEN.
IN MY 
VIEW WHAT WE ARE SEEING IN VIOLENCE IN OUR SOCIETY HAS  AS ONE ROOT
CAUSE, 
OUR BROKEN MENTAL HEALTH INFRASTRUCTURE.  

Kenneth L. Mattox, MD
Houston

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