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States have been cutting back on facilities for the mentally ill for years, and the economic downturn has made one problem, in particular, worse. Mentally ill patients who end up in emergency rooms can get stuck there for days, waiting to be transferred to psychiatric hospitals that are short of beds.

Jenny Gold, of our partner Kaiser Health News, recently traveled to Rhode Island and has this story.

(Soundbite of ringing phone)

JENNY GOLD: By the time I reached Erik on a cell phone at Pawtucket Memorial Hospital, he'd already been waiting in the emergency room for nearly 30 hours.

ERIK: It's 5:50 on Wednesday afternoon. I've been here since about noon yesterday.

GOLD: Erik asked us not to use his full name out of concern for his business and personal relationships. He's 40 years old, and he's been diagnosed with PTSD and schizoaffective disorder. Erik ended up in the ER after calling the police to report a theft in his apartment.

ERIK: Police showed up and pretended that I was the problem, began asking me for ID; questioning me. And then they said well, you need help, come on; were going to take you to get help. And they forced me down into the ambulance and drove me there.

GOLD: The E.R. staff asked Erik to remove his clothing and put on a hospital gown instead. He refused.

ERIK: And they proceeded to grab me, pull my clothing off, strap me down to a bed with four-point restraints.

GOLD: The hospital declined to comment. But according to medical records, Erik was restrained for several hours. The E.R. staff quickly determined that he needed to be transferred to a psychiatric unit. But as is the case for many hospitals, Memorial doesn't have one - and all of the neighboring hospitals were full.

ERIK: I would really like to get out of here.

GOLD: This isn't the first time he's been there. Erik has gotten stuck in the E.R. multiple times. He's bright, articulate, devoutly religious - and fairly typical. Patients like him are waiting in emergency rooms across the country.

Since 2009, 32 states have cut their mental health budgets, largely from the outpatient services that keep people healthy and out of the E.R. Yet there's a greater need than ever for the services, as more Americans have lost their private insurance.

Dr. GARY BUBLY (Emergency Physician, Miriam Hospital): Every day when I go to work and I see this, I just think it's the - you know, thing that's most wrong with the health-care system. I sincerely mean that.

GOLD: Thats Gary Bubly, an emergency physician at the Miriam Hospital in nearby Providence. He says Erik's situation is not unusual.

Dr. BUBLY: I don't think this would be tolerated with any other illness. If somebody had pneumonia and they were admitted, they wouldn't be told they have to wait anywhere. We talk a lot about mental health parity, but I think this is an example where there clearly, is not parity.

GOLD: Bubly is also the president of the Rhode Island Medical Society. He says the emergency room is one of the last places you'd want to be in the midst of a psychiatric crisis.

Dr. BUBLY: The inside of the E.R. is kind of like Las Vegas. You know, there's a 24/7, 365 flow of activity that's going on there.

GOLD: In the Miriam emergency department, 40-some doctors and nurses on the afternoon shift are rushing back and forth with clipboards and stethoscopes, rolling patients on gurneys and tending to those parked in the hallways.

The unit is divided into small patient corridors, each cordoned off with a pastel floral curtain that ends about two feet above the floor.

Dr. BUBLY: I'll just close this. It doesn't provide much of a sound or privacy barrier to - so if you picture either you're a poor, depressed patient over here and there's some other chaos going on next door, you really never get a break from the noise and commotion that's going on.

GOLD: And treatment here is minimal. They can receive drugs, but not much counseling. It can also be damaging for the other patients around them.

Dr. BUBLY: If there's a noisy, disruptive psychiatric patient over there, and you're over here having a heart attack in this bed - you know, again, there's going - always wondering gee, is anybody watching that guy over there? Is that person going to come hurt me or do something?

GOLD: This afternoon at Miriam, there are two psychiatric patients waiting for a bed. Each one is monitored, day and night, by a security guard sitting in the hallway outside their curtain, slowing down the flow of traffic in the E.R.

Depending on the insurance status of the patient, the E.R. may also be absorbing most of the costs. And for every hour that a mentally ill person gets stuck here, another patient can't get in. Right now, there are six people waiting in triage. The next day, I call to check in on Erik at Memorial Hospital. He was still waiting.

What time is it right now?

ERIK: Ten minutes till 12, I suppose. That's noon.

GOLD: And the hospital wasn't giving him much hope that he'd be leaving anytime soon.

ERIK: They said there are no beds in the state of Rhode Island. And they said it could be two days; it could be five days - it could be a week.

GOLD: Over the past two years, states have closed or are planning to close nearly 4,000 state psychiatric beds, about 8 percent of capacity. Recently, Rhode Island added some back. Craig Stenning is the director of the state's Department of Mental Health. He's been working closely with hospitals since 2008 to reduce their wait times. And he says he's made significant progress.

Mr. CRAIG STENNING (Director, Rhode Island Department of Mental Health): We'll never be satisfied completely. Some of it is out of our control. And some of it, hopefully, we can continue to make some progress with.

GOLD: But despite these efforts, some psychiatric patients in Rhode Island are still waiting a very long time. Reed Cosper is the state's mental health advocate, a lawyer appointed by the governor to defend and advance the rights of the mentally ill.

Mr. REED COSPER (Rhode Island State Mental Health Advocate): Emergency rooms are for people with heart attacks and gunshot wounds. And it is just a disgrace that mentally ill people can be held two, three, five days - eating ham sandwiches in total chaos.

GOLD: Cosper is a tall man in a houndstooth jacket, a bright-yellow tie and a Stetson. He looks a little like a detective in an old movie, and he's been on this case for the past 20 years. He says he knows where patients ought to be treated places like Butler Hospital, the largest psychiatric hospital in Rhode Island.

Mr. COSPER: We're sitting on 100 acres of conifers and deciduous trees, overlooking the Seekonk River.

GOLD: Butler is a sprawling, brick building from the 19th century - with tall turrets and a glass gazebo out front.

Mr. COSPER: At Butler, the mental health law compels the hospital to provide privacy and dignity to every patient; have religious freedom; to be visited privately at all reasonable hours.

GOLD: After 42 hours in the E.R., Erik was finally transferred here. Cosper takes me to see him in the intensive-treatment unit. The hallways are crisp and tranquil, and when we walk in, two patients are playing a game of ping pong. Erik is wearing his own blue flannel shirt and khakis. His shoulder-length hair and mustache are carefully combed.

ERIK: Wear my own clothing, and take a shower, and use the facilities without somebody watching me or insisting that the door be open. And I think that's like, a minimal level of humanity that should be accorded to every human being.

GOLD: What were you thinking in that moment when they told you at last that you would be moved to Butler?

ERIK: I just said thank God. Thank God.

GOLD: Not all psychiatric hospitals are as picturesque as this one, and many present their own share of problems. But at least they were designed for patients like Erik. For now, he's in the clear. After seven days at Butler, Erik went home. But he says he's scared that before long, he'll end up stuck in another E.R. yet again.

For NPR News, I'm Jenny Gold.

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