Given the continued emphasis on cost cutting, implementing effective measures, and streamlining services in healthcare, some cutting-edge emergency departments are moving from their usual psychiatric screeners to psychiatric screamers. This is the brainchild of Dr. Buster Loude, who had been hauled into his medical director’s office again after his voice-to-text program put “psychiatric screamer” rather than “psychiatric screener” in the EMR and he failed to correct it. However, this happy accident lead to his brilliant idea to actually have psychiatric screamers in his department, so the successful pilot program was born. The idea has spread like wildfire to other emergency departments and is being considered for inpatient use.
Psychiatric screening of emergency department patients is extremely labor intensive, requiring specially trained staff to conduct elaborate interviews and up to two hours to complete and document. Further, the process may accidentally validate many of patient’s primary delusions, unfortunate behaviors, and psychological issues, as they rehash their often lengthy and traumatic psychiatric and life histories. While some patients clearly enjoy the opportunity to relate their extensive addiction history or abuse stories, many others fail to gain any therapeutic benefit from the process, and the interviews may fail to address key behaviors and attitudes that are adversely impacting their mental health.
Psychiatric screamers, by comparison, simply have to walk into the room and get to the point, often starting with the standard opener, yelled at high volume inches from the patient’s face, “What the hell were you thinking?”, typically followed rapidly by, “Quit acting like a lunatic!”, “Stop smoking crack!”, “Take your friggin’ risperidone, Dude!”, “Get over yourself and get a job!”, or “Stop overdosing and cutting your wrists right now and never, ever do it again!”, with each admonishment carefully selected as appropriate for maximum therapeutic effect.
Many patients are responding quite positively to these direct interventions. One was heard to comment, “You know, I hadn’t realized that it might be the nine-day methamphetamine binge that made me so paranoid, and their advice to quit shooting speed really was a wake-up call! I had never thought of that, but now I am really going to turn my life around! Thanks!” Another was reported to have said, “You could tell that they cared deeply about me in this emergency department, as they had the guts to really get to the heart of what was going on with me. Who knew it could just be as simple as actually taking my lithium and haloperidol like I was supposed to? Nobody had ever told me that before. This ER rocks!”
Further, psychiatric screamers have reported an extremely high degree of job satisfaction, and burnout rates have been dramatically lower than noted in traditional psychiatric screeners. Also, these interventions typically take less than 5 minutes, meaning that a psychiatric screamer may be able to treat between 8 and 20 patients it in the same period of time that a traditional psychiatric screener would have taken to see just one patient. These sorts of extreme efficiencies are getting noticed.
CMS has been excited about the project. Dr. Bradley Wangwinger, director of CMS’s mental health division, was lucky enough to be doing an internship with CMS back in the Reagan era when they dismantled most of the antiquated and expensive residential health treatment facilities across the nation, kicking patients the streets where they belonged. For years he had been looking for an opportunity to do something as grand and daring as the Reagan-era pioneers, so has jumped whole-hog on the psych screamer bandwagon.
Exclaimed Dr. Wangwinger at a recent CMS budged hearing, “I think that we are going to be able to cut costs dramatically, directly address the essential mental health issues affecting patients, and eliminate a tremendous amount of waste in the system with this new program! We are all thrilled by these cutting-edge innovations here in Washington, and I think that the new administration will be all for it, as screaming at the mentally ill seems right up their alley. I have even been implementing some of their ideas in my own clinical psychiatric practice, and patient’s love it! They really feel understood and come away knowing exactly what they need to do to get better. It’s a win-win all around! We are so happy with the results, we will be implementing a new pilot program using psychiatric screamers on demented and delerious elderly patients as well, and we think it will be similarly successful. The kids will be next, of course, we’ve got to do this to the kids…”
