Metro Detroit hospitals are being forced to treat an increasing number of mentally ill patients in emergency rooms because of a lack of mental health care services and the closing of short- and long-term care facilities.

Mental health patients seeking psychiatric care in emergency departments account for a growing portion of the $1.2 billion in unpaid patient bills that hospitals in Michigan sustain each year. Locally, hospitals report increases as high as 200 percent in the number of psychiatric patients in emergency rooms, and 60 percent of doctors nationally say they have noted an increase in the past six to 12 months.

Health care officials and doctors attribute the trend to deinstitutionalize mental patients in the state of Michigan over the past 20 years, the lack of psychiatric beds in hospitals and the dysfunction of the community mental health system. They say a tough economy and stressful times contribute to more people who are mentally ill seeking limited services.

"Everyone tells you it’s the family’s problem, and you have to deal with it," said Jason Chorney of Troy, who frenetically searched this month for more appropriate care for his mother-in-law. "It is difficult to find anything, and they want you to drain your family’s savings."

Local doctors and health care administrators say the trend could not be occurring at a worse time. Emergency rooms already are more crowded with the growing number of uninsured and under-insured.

"Access to health care does not mean access to emergency departments," said Dr. James M. Fox, vice chairman of emergency services at St. John Hospital in Detroit. "This is no way of providing health care to the citizens of the state."

David Littmann, chief economist at Comerica Bank, said hospitals in southeastern Michigan sustain $423 million in unrecoverable costs in emergency rooms — an undetermined portion is for people who are mentally ill.

"It is a fantastically bankrupting number," Littmann said. "It takes away money from other areas of health care, and there is, by far, a much higher cost in the ER than treatment in other areas of the hospital."

The number of people with mental illnesses seeking care in the emergency rooms at the Beaumont Hospitals in Royal Oak and Troy spiked in the first four months of the year. Over the course of this year, the emergency department visits are projected to grow by 10 percent, from 2,802 to a projected 3,096.

The four hospitals in the Oakwood Healthcare System are experiencing a 7 percent increase in emergency room visits by the mentally ill this year, hospital officials said.

And St. John Hospital in Detroit has seen more than a 200 percent increase since 2002, from about 150 visits to about 500. The increase at St. John also is affected by the closing of other emergency rooms in the same area in recent years.

Doctors and administrators say that while they are concerned about the costs of emergency care, their greater concern is that it is often inappropriate for the mentally ill.

"We are not set up to provide ongoing care, and what most psychiatric patients need is ongoing care," said Dr. Andrew Wilson, chief of emergency medicine at the Beaumont hospitals.

The problem even affects families that have long experience dealing with the community mental health system.

Hope Cummins of Farmington Hills says her daughter, Paige, 37, gets good care from Oakland County while living in her apartment. Paige has been diagnosed as suffering from the neurologic disorder schizophrenic and affective disease. She lives in her own apartment, but she requires a 24-hour attendant.

As an active member of the Alliance for the Mentally Ill of Michigan, Hope Cummins is so knowledgeable that she frequently advises other families about how to get community services.

But when doctors and the Cumminses decided to try a new medication for Paige earlier this month to help her live more independently, trouble ensued. Paige required immediate psychiatric care, and when the normal intervention center was too full, the Cumminses went to the emergency room at St. Joseph’s Hospital in Pontiac.

Cummins says she feels lucky that the hospital was eventually able to provide in-patient care for Paige.

"It was just a really stressful time," Cummins said. "She needs strict supervision."

Michigan is part of a national trend in increasing emergency room visits by the mentally ill.

The influx is clearly having a negative impact on services in the emergency department, according to about 81 percent of the doctors. About 89 percent of the doctors said the situation frustrates the other patients in the emergency department.

"This increase in patients who are mentally ill adds fuel to the fire," said Dr. J. Brian Hancock of Saginaw, president of the American College of Emergency Physicians. "The reality is: I have been practicing in Michigan for 20 years and the ability to get care for mental health patients has always been a struggle. But it seems like in the past several months, it has gotten worse."

Part of the problem, experts say, is the state’s assumption in the 1990s that as it closed mental hospitals, private hospitals would open psychiatric facilities to profit from the new demand. Observers say that was a major error.

In Wayne County, for example, the number of available hospital beds for the mentally ill is down by 60 percent since 1994, to 310, according to the Michigan Psychiatric Society.

In Oakland County since 1994, the number of beds has declined from 875 to 415.

In Macomb, the 10-year decline is from 204 beds to 24.

"The point is, there is nowhere for these people to go," said Kathleen Gross, executive director of the Michigan Psychiatric Society. "I think the trend is reaching crisis proportions."

For children, the situation is even more dire. In the tricounty area, there are just 55 beds at Havenwyck Hospital in Auburn Hills.

"Children are continually deteriorating and then having to go back to emergency rooms at hospitals," said Susan McParland, director of the Michigan Association for Children with Emotional Disorders. "They are in and out, like gypsy moths."

The economics of health care has dictated that private institutions would never fill the gap the state purposefully devised when it deinstitutionalized mental health care, doctors say.

"Hospitals, especially those struggling to survive, will close psychiatry units and open more cardiology or more surgery because those areas are more profitable," said Dr. Elliot Luby, the former chief of psychiatry at Harper Hospital who was the head of clinical service at the now-closed Lafayette Clinic in Detroit from 1957 to 1974. "And it is just fact that cardiology makes more money than psychiatry."

Jason Chorney and his wife, Daniella, describe desperate situations in which a hunt for more appropriate care for Daniella’s mother proves so futile that emergency departments become the only option.

"It’s a terrible situation," Daniella Chorney said. "Bringing her to the emergency room is one way of taking care of her. But she belongs in a facility that can take care of her permanently."

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Emergency department doctors in Metro Detroit and nationally say they are experiencing an increase in the number of people who are mentally ill who seek care in emergency rooms.

Locally, some hospitals report increases ranging from 7 percent to as high as 200 percent. And nationally, 60 percent of emergency room doctors surveyed say they have treated more people who are mentally ill in the past six to 12 months.

Experts and observers say the trend adds to health care costs because emergency care is often more expensive. It also adds to unrecoverable costs because much of the care in emergency rooms is received by people without insurance.