Is discharging an acutely disturbed young man to the street, because there were insufficient beds in Western Virginia, “parity” for psychiatric illness treatment under the law? Would a hospital emergency room release to the street someone who came in with a life-threatening medical condition, say a heart attack? Yet this is done routinely with emergency psychiatric patients. Beds an always be found. Medical beds can be converted to temporary psychiatric beds but merely employing “sitters” to remain with the patient constantly until a bed opens on a safe, closed psychiatric unit and the patient can be transferred.
Although the vast majority of psychiatric patients are LESS dangerous than the general population, those mentally ill people with acute psychotic disorders, particularly if they exhibit paranoid or persecutory delusions, can be considerably more dangerous and even life threatening to themselves or others. No emergency room psychiatrists has a crystal balls and can predict in an absolute sense with 100% accuracy dangerous human behavior. Nevertheless, risk assessment is not “prediction,” risk assessment is not prediction – it is an actuarial judgement. That is, it is an attempt to answer the questions of whether based upon the presence or absence of certain known risk factors, does a given individual have a statistically greater, lesser or equal chance of imminently acting violently against himself or others compared to someone without his mental condition? Though not perfect, this is very useful tool and when employed properly can provide a statistically meaningful margin of safety for the general public.
When there is a possible risk of violence against self or others, an acutely disturbed psychiatric patient MUST for hospitalized for up to 72 hours close observation and, if indicated, emergency treatment in order to determine whether the individual poses an imminent risk to himself or others and, if he does, to reduce that risk. When we and our institutions do anything less inevitably based upon fiscal austerity, we are playing “Russian Roulette” increasing the chances of a tragic fatal outcome which no “cost savings” can justify.