Struggles, Within and Without: The Ways Mental Illness Can Hurt Your Emergency Care

by UMass-Amherst student Jesse Arsenault (2018)

The emergency room can be a chaotic place, and few know this better than the physicians and nurses who work there and are responsible for analyzing, treating, and prioritizing the ailments and injuries continuously pouring in, night after night. This high-stakes, high-tension environment can place tremendous amounts of stress on both patient and provider – sometimes with serious, life-threatening consequences.

An environment where emotions run so high makes an ideal laboratory (so to speak) for Dr. Linda Isbell, a professor of Psychology at UMass Amherst. Isbell’s research has historically focused on the roles our emotions play in a variety of daily contexts, such as our politics and relationships. However, she has recently been awarded a $1.71 million grant to study a more intense type of emotional exchange: the interactions between mentally ill patients and the ER workers assigned to care for them. Isbell is enthusiastic about this new strand of psychological work. “This is the research that I’m most excited about, and that I think is most important,” she says, adding that this type of research is still “a relatively new field.”

The field is not only new: it is also becoming increasingly relevant to the American population at large. As recently highlighted by NPR, patients with severe mental illnesses can be the victims of extremely poor ER care, a failure that can sometimes cost the patient their life. Further complicating the matter, the ER is also frequently used by other vulnerable populations, such as the homeless, in their attempts to seek quality care and refuge from the elements. People with substance abuse problems or thoughts of suicide may turn to the ER when they are most in need – but over time, some ER workers have grown skeptical of such claims, as they are often exploited by those without mental illnesses in order to receive immediate care of their own.

“In order to get their [basic physical] needs met, they may need to come and say they’re suicidal whether they’re suicidal or not,” she explains. The problem does not end there either. Even when a patient truly does have a mental illness such as schizophrenia or bipolar disorder, any altered temperament or erratic behavior can lead to poor treatment from exhausted hospital staff.

Though her research began with a focus on the patients themselves, Isbell makes it clear that both parties are actually getting a raw deal. On the one hand, these ER patients are already high-risk – people with mental illnesses tend to die 15 to 20 years earlier than those without, according to Isbell. “This patient population doesn’t always get appropriate treatment, and there is a real stigma against them…there’s no reason to think that physicians and nurses are immune to that.”

However, she recognizes that part of the issue lies in the massive stress under which these workers operate, and she doesn’t want to imply that physicians and nurses are being actively malicious or abusive. “They’re doing a tremendous job,” she adds, “they just have a tremendous burden on their shoulders.”

As a result, Isbell’s research is set to focus on the problems of both mentally ill patients and the medical specialists who treat them. Her study, split into three phases over the course of five years, will begin with qualitative interviews before progressing on to controlled experiments, examining how emotions and knowledge of mental illnesses in patients can affect the treatment of those patients. Finally, Isbell hopes to suggest evidence-based improvements to existing ER protocols which will, hopefully, better suit the unique needs of the mentally ill.

“It’s a tall order,” to demand even more labor on the part of ER workers, she recognizes, “It’s because you’re a human being…we are all biased in some way.” In the long-term, Isbell hopes that her research will help ER physicians and nurses to recognize their own biases, and to, in turn, provide better and more compassionate care to those who struggle with these illnesses both inside and outside the emergency room.