SURVIVORS WITH MENTAL ILLNESS IN THE EMERGENCY ROOM
For many survivors of sexual violence, their first interactions with institutional support are with emergency departments of hospitals. These emergency rooms (ERs) can be places where survivors receive a great deal of support during incredibly vulnerable and painful times of their lives. ER staff can give first aid and assist with other medical needs, administer emergency prophylaxis and contraception, perform sexual assault forensic exams (AKA rape kits) and/or put survivors in contact with important law enforcement and mental health resources.
ER visits are particularly important for survivors of sexual assault with mental illness. People with psychiatric conditions often already rely on the ER for treatment and make up 6% of all ER patients (Luthra, 1). According to clinical assistant professor in emergency medicine at Stanford University, Suzanne Lippert, this reliance on the ER comes from a lack of “good outpatient treatment for mental health problems” (Luthra, 1). Furthermore, survivors ER visit may be the only institutional support that they get for their assault. Because people with mental illness are at reduced odds of “attending the medical/counseling follow-up appointment” (Darnell, 1). In addition, according to associate professor of emergency medicine and pediatrics at Brown University, Dr. Thomas Chun, problems for people with mental illness arise in emergency departments because ERs were not set up to be good environments for these types of patients (Luthra, 1).
Some of the most extreme examples of retraumatization happen to survivors with mental illness. For these survivors, ER staff may not believe the survivor or take their trauma as seriously because of stereotypes about mental illness. This doubt manifests itself through ER staff lying to the survivor, not taking the survivors requests seriously and/or being particularly rude and apathetic when assisting the survivor. These can all be painful for survivors of sexual trauma with mental health disorders because they are already observed for longer and wait longer to be transferred and discharged than patients with exclusively medical conditions (American Psychiatric Association, 1). They may have to be under forced observation for psychiatric reasons, such as a history of suicide attempts. Waiting in an intensely bright, cold, and strange room for hours with rude or actively belligerent staff is one of the last thing that a survivor wants to be doing after experiencing sexual violence.
Sexual violence is inextricably linked to mental health. People who have experienced gender based violence “are at higher risk of major depressive disorder and suicide attempts than those without such a history” (Ranney, 1). Add on other difficult factors that negatively affect survivors with mental illness like substance abuse, and emergency rooms can become incredibly hostile places for many survivors. In fact, they may decide not to come back to the ER if they are ever assaulted again.
The point of this blog is not to depress you (though it may have done that regardless). As we strive to create a society that supports all survivors of sexual trauma, we need to recognize that different survivors have individual needs and struggles. We need to change structures, like that of the ER, to support survivors as well as work to become the most empathetic and supportive allies we can be.
Luthra, Shefali. “How Gaps In Mental Health Care Play Out In Emergency Rooms.” NPR, NPR, 17 Oct. 2016, www.npr.org/sections/health-shots/2016/10/17/498270772/how-gaps-in-mental-health-care-play-out-in-emergency-rooms.
Darnell, Doyanne, et al. “Factors Associated with Follow-Up Attendance among Rape Victims Seen in Acute Medical Care.” Psychiatry, U.S. National Library of Medicine, 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4777603/.
Emergency Room Visits for Mental Health Conditions: Expect Long Waits.” Emergency Room Visits for Mental Health Conditions: Expect Long Waits, American Psychiatric Association, 10 Nov. 2016, www.psychiatry.org/news-room/apa-blogs/apa-blog/2016/11/emergency-room-visits-for-mental-health-conditions-expect-long-waits.
Ranney, Megan L., et al. “Gender-Specific Research on Mental Illness in the Emergency Department: Current Knowledge and Future Directions.” Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, U.S. National Library of Medicine, Dec. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4271843/.