“They're taking up beds”: Psychiatric emergency staff attitudes towards patients presenting with substance use needs

Background: Patients with substance abuse problems are over-represented among those seeking care in emergency settings, including psychiatric emergency rooms (PERs). Patients with dual recovery needs often present complex treatment concerns in such settings. Despite the high percentage of people seeking care in PERs with substance abuse problems, little is known about how PER staff think about these patients and the ways in which this might shape their work and the care that they provide. Methods: As part of a larger mixed-methods study two qualitative interviews were conducted with staff (N=16) of a busy urban psychiatric emergency room. Results: Several important themes emerged. First, many staff expressed the belief that patients with substance abuse problems were not “real psych”, (i.e. did not present with legitimate psychiatric problems) and were therefore inappropriately using the PER. Second, most staff expressed little hope for patient recovery or improvement, prompting them to question whether they were capable of providing meaningful care to these patients. Third, staff described the how interactions with substance abusing patients often challenge their desire to be empathetic providers. This seems to be particularly important for patients for whom substance abuse (rather than “real psych” issues) was seen as the most salient problem. Conclusions: These data suggest that PER staff share common experiences and beliefs about patients presenting at the PER with substance abuse problems. These must be understood to better meet the needs of people with substance abuse problems seeking care and the people who work in these settings.