Service members who suffered moderate to severe traumatic brain injury in combat have significantly higher incidence of mental health disorders in following years as compared to warfighters who sustained other traumatic injuries, a study found.

The study, published in the current issue of the journal Military Medicine, examined almost 5,000 cases of traumatic injury experienced by Marines, soldiers, airmen and sailors during combat operations in Iraq and Afghanistan from February 2002 to February 2011.

Among the study’s findings is a clear relationship between moderate and severe brain injury and a greater risk for post-traumatic stress disorder, a link that contradicts a theory posited by some previous researchers.

Traumatic brain injury has been the scourge of U.S. combatants during the extended war on terrorism, particularly the decade after the September 2001 World Trade Center attack. Improvised explosive devices were the weapon of choice by enemy guerrilla fighters in Afghanistan and Iraq.

Improvements in body armor and medical treatment saved the lives of many blast victims who would have died in earlier conflicts.

By 2010, 7,832 warfighters had survived severe traumatic brain injury, the study said.

Boarding of psychiatric patients in medical emergency departments (EDs) for hours or even days is a serious issue plaguing hospitals across the country. Typically, the emergency physician has determined that the patient needs further psychiatric care. However, the sole option available is usually admission to an inpatient psychiatric facility.

Unfortunately, few regions have enough inpatient psychiatric beds to meet the needs of a system predicated on admitting the majority of ED patients, especially since, in the past decade, behavioral health patients have risen to become one in every eight cases in EDs in the US. 

As a result, psychiatric patients can end up confined indefinitely in small ED quarters with a sitter or security guard, or restrained to a gurney in a back hallway, while they await admission.

Many of these boarded patients receive little or no psychiatric treatment beyond sedation. Thus, sadly, the most highly acute patients in a mental health system are often ironically the most underserved.

Fortunately, we now have an evidence-based solution that can fill this glaring gap in the psychiatric care continuum: hospital-based psychiatric EDs.

These timely, compassionate, trauma-informed, and cost-effective programs have the potential to not only dramatically improve treatment options, but also save behavioral health systems millions of dollars annually by stabilizing patients in the emergency setting, and thus avoiding costly inpatient admissions.

Hospital-based psychiatric EDs are also known as Psychiatric Emergency Services (PESs), Comprehensive Psychiatric Emergency Programs (CPEPs), Clinical Decision Units (CDUs) or, more recently, EmPATH Units (Emergency Psychiatry Assessment, Treatment and Healing Units).

Psychiatric EDs have been shown to stabilize over 75% of high-acuity psychiatric outpatients within 24 hours.2 These units provide far faster relief from distressing mental health symptoms than traditional treatment pathways while preserving inpatient psychiatric beds for patients who truly have no alternative.

This article, the first of a three-part series, describes how hospital-based psychiatric EDs differ from community-based crisis centers.

Also explored is how these centers can serve as the missing link in comprehensive behavioral health systems while complementing both inpatient and community services.

The second installment will highlight innovative psychiatric ED programs around the nation and their impressive outcomes and metrics.

And in the final installment, the perplexing reimbursement issues facing psychiatric EDs will be discussed with strategies to overcome them suggested.

As the homelessness crisis in California grows more acute, Gov. Gavin Newsom is planning to ask lawmakers for $1.4 billion to pay monthly rents, build more shelters and provide treatment to those struggling with finding long-term housing, the governor's office announced on Wednesday.

Newsom also signed an executive order directing agencies to locate public properties near state roads and highways that can be used for short-term emergency shelters. The order additionally calls for using 100 camping trailers for temporary housing and the development of a multiagency "strike team" to help get people off the streets.

"Homelessness is a national crisis, one that's spreading across the West Coast and cities across the country. The state of California is treating it as a real emergency — because it is one," Newsom said in a statement, describing his budget proposal on homelessness a "massive infusion of state dollars."

The ambitious plan comes in the context of a mounting homelessness crisis in the state.

A report released Tuesday from the U.S. Department of Housing and Urban Development underscored the depth of the homelessness problem in California, finding that more than a quarter of the nation's homeless population resides in the state, totaling about 151,000 people.

The report noted that while homelessness declined in most states over the past year, it went in the opposite direction in California, where the homeless population jumped 16% in one year.

In a briefing with reporters, a HUD official said the response to homelessness in California is not at the scale of the problem.

"Affordable housing problems are a massive and overwhelming contributor," said a top HUD official, speaking on background. "Certainly any efforts to make housing more affordable and to increase the supply of affordable housing and to increase development of housing — those are all going to be important to turning the ship around and reducing homelessness."

Trump's feud with California officials over homelessness problem

The briefing came as the Trump administration doubled down on criticism of state leaders in California for not adequately dealing with the state's swelling homeless ranks.

President Trump has repeatedly attacked state lawmakers' inability to curb the state's homelessness problem, vowing to enlist the federal government to get involved if the crisis does not start turning the corner.

"It's a shame. The world is looking at it," Trump said in September of the state's struggles with homelessness.

The White House has blamed the "overregulation of housing markets" on the country's homelessness issues.

Last year, Trump sent a team of aides to California on a fact-finding mission on solutions to homelessness in the state. The administration is weighing a number of proposals, including moving those who do not have permanent, stable housing into refurbished federal facilities, but it is not clear how the idea would work in practice.

In October, the Environmental Protection Agency issued a notice to San Francisco officials that they were violating the Clean Water Act for polluting ocean waters with homeless encampment drainage, an allegation one elected official in California called a "fraudulent political attack."

A $1.4 billion plan to combat homelessness

Newsom is hopeful his proposal, expected to be sent to state lawmakers on Friday, will put a dent in rising homelessness in the country's most populous state.

According to California officials, most of the money in Newsom's plan, or about $750 million, would be placed in a special fund to pay the rent of individuals facing homelessness and to spur the building of affordable housing.

The money would be drawn from a one-time fund of surplus tax revenue collections as the state expects another tax collection windfall in the coming year of about $7 billion.

Another large slice of funding — $695 million — is to boost the state's Medicaid programs to expand services for homeless individuals whose housing struggles are directly linked to health problems.

"Californians have lots of compassion for those among us who are living without shelter. But we also know what compassion isn't. Compassion isn't allowing a person suffering a severe psychotic break or from a lethal substance abuse addiction to literally drift towards death on our streets and sidewalks," Newsom said.

Newsom hopes the taxpayer-funded plan begins to put a dent in the homeless crisis, but he is calling on philanthropy and the private sector to address California's deep homelessness problem.

The formal state budget proposal from Newsom is expected on Friday, and the legislature has until June 15 to pass a deal.