California tracks ICU survival rates — while ignoring mental toll on patients | Opinion

California leads in medical innovation, yet it overlooks one of the most damaging outcomes of critical illness: the psychiatric injuries sustained in intensive care units (ICUs).

While major hospitals in Los Angeles and the Bay Area have access to psychiatric departments, many rural and community hospitals lack any mental health support in critical care. The result is life-saving treatment that too often leaves patients psychologically shattered — with no system prepared to help them recover.

Delirium, an acute brain failure common in ICU care, often goes unrecognized and untreated. According to a major study, up to 80% of mechanically ventilated patients experience delirium marked by hallucinations, agitation and severe disorientation. Far from temporary confusion, delirium is linked to long-term harm such as depression, cognitive decline and post-traumatic stress that can last for years.

Several years ago, I was admitted to a community hospital on California’s Central Coast with a life-threatening illness. I spent nearly two months on a ventilator. When I regained consciousness, I found my wrists restrained. I could not speak. I didn’t know where I was. I believed I was dying. I was hallucinating — a clear sign of ICU delirium — yet no psychiatrist evaluated me. I survived, but survival was only the beginning.

My decline continued after discharge. When I was finally released from Marian Regional Medical Center in a confused and disoriented state, I was transferred to a rehabilitative hospital in Los Angeles to be weaned off the ventilator. But I had no will to undergo the breathing trials required to start breathing on my own. I couldn’t sleep, awakening repeatedly in panic. I lost my will to recover.

My daughter, alarmed by my distress and unable to communicate with me because I was unable to speak on a ventilator, contacted my doctor. A psychiatrist was finally called in. He ordered an antidepressant — and the change was immediate. My panic eased, I passed the weaning trials quickly, and my recovery finally began. It should not have taken weeks of suffering for psychiatric care to enter the picture.

ICU survivors have lost careers, marriages and cognitive functions

Three years later, I live with anxiety and depression I never had before. My cognitive function has changed. Writing — once instinctive — now requires focused and exhausting effort. I have met other ICU survivors who lost far more: careers, marriages, the ability to recognize their own lives. Not one of us was counted in hospital outcome reports.

Without psychiatric involvement, many ICU patients in California are physically restrained rather than evaluated. Safety warnings from national hospital regulators caution that restraints prolong delirium, increase injury risk and may cause lasting psychological trauma. But in many rural hospitals — including on the Central Coast and in the Central Valley — restraints are used simply because no psychiatric alternative exists.

Urban hospitals often have consultation-liaison psychiatrists who can assess delirium, adjust medications and guide behavioral interventions. Rural hospitals do not. According to California’s Office of Health Care Access and Information, all 58 counties face psychiatrist shortages, and 37 counties have shortages of 50% or more. Meanwhile, the California Hospital Association reports that 24 counties have no in-county access to acute psychiatric hospital services, leaving large regions without hospital-based psychiatric care.

The medical community has a name for the outcomes many survivors face — Post-Intensive Care Syndrome (PICS) — encompassing PTSD, memory loss, mood disorders and cognitive injury. Yet California health policy does not require hospitals to screen for PICS, track delirium or provide referrals for psychiatric follow-up.

This cannot be solved by hospitals alone. State policy must change.

Next steps for treating ICU patients

California should act now to:

• Require delirium and restraint reporting in quality metrics

•  Fund psychiatric consultation in ICUs through Medi-Cal

• Create a statewide ICU telepsychiatry network

• Establish post-ICU recovery clinics

California cannot claim to lead in health equity while ignoring psychiatric injury in critical care. ICU survival must no longer be considered success on its own. Recovery must include the mind.

Jill Stegman writes about health policy and patient rights in California and is the author of “One Pill Makes You Stronger,” a memoir about psychiatric injury and medical oversight.