Carly Whelan thought sitting in prison would be an improvement over the conditions inside ECMC’s comprehensive psychiatric emergency room. This past spring, police brought Whelan to CPEP, ECMC’s 24-hour comprehensive emergency psychiatric center in Buffalo, for being a suicide risk.

She entered a large cafeteria-style room with about 45 other strangers who were in the throes of their own mental health crisis.

She said patients were treated “like animals.” She saw a patient urinate on the “filthy” floor next to where people tried to sleep. She did not see a doctor for over a day until her mother reached out to a patient advocate, whom she credited for getting her seen faster than other people had experienced. She never got the depression medicine she brought with her and found the stale sandwiches unappetizing.

“It was kind of like a disaster in there,” said Whelan, who spent 27 hours in CPEP before being discharged.

Whelan was so disturbed by the experience that she left a one-star negative review on ECMC’s Google page: “Being in that room alone is enough to make you spiral mentally. I can’t believe people who are already going through such a rough time mentally and emotionally are forced to be in such conditions.”

Carly Whelan said she would never go back to CPEP after her experience last year.

Whelan is among 16 former patients and their relatives interviewed by News 4 Investigates over a two-month period who said ECMC CPEP seems to have strayed from its purpose of providing emergency psychiatric observation, evaluation, care, and treatment in a safe and comfortable setting.

By no means did the former patients expect paradise, but they did not feel safe or comfortable at ECMC’s CPEP, often the busiest program in the state, serving some 10,000 adults and children a year.

Current and former employees told News 4 Investigates that a staffing crisis has fueled most of the problems, and they blamed ECMC administrators for brushing off their concerns about hiring more people and violence in the mental health wing.

A News 4 Investigates analysis of two 2019 datasets on wait times and ECMC employee injuries found the following:

  • About 30% of ECMC CPEP patients that year waited longer than a day for the doctor assessment that would determine if they would be discharged, which was the second-worst rate of the 22 CPEPs in the state.
  • Workers that year reported injuries from violent interactions with patients in CPEP or one of the behavioral health units more than once a week, with some missing up to six months of work.

Dr. Michael Cummings, ECMC’s associate medical director who oversees CPEP and Behavioral Health, estimated staffing is down 16%. But he said violent interactions have dropped considerably from the prior year.  

Bottom line, Cummings said the mental health system is chronically underfunded and Medicaid reimbursement rates are insufficient. As a result, ECMC’s Behavioral Health units reported $15 million in losses for 2021.

“Do we have places to grow and improve?” Cummings said. “Absolutely. Even if there are zero complaints, if you’re not moving forward, you’re falling behind.”

The birth of CPEPs

Before CPEPs, patients that needed emergency psychiatric care often went to medical emergency rooms, while state-run psychiatric centers treated those with more serious and persistent mental illnesses.

In the mid-1980s, New York transitioned to community-based programs and began to close or reduce the size of the state-run psychiatric centers.

This transformation, however, overwhelmed community organizations, which resulted in further overcrowding of medical emergency rooms.

In 1989, the state developed the legal framework for the Comprehensive Psychiatric Emergency Program so that hospitals could offer a full range of emergency psychiatric care and curb unnecessary visits to  medical emergency rooms.

State law requires CPEPs to provide crisis intervention, extended observation rooms with beds, mobile crisis outreach services and treatment rooms for extended stays. The idea behind it was that CPEPs would provide quicker triage, assessments, and intervention in a “safe and sanitary environment” that is free of abuse and mistreatment.

But former patients told News 4 Investigates that not only did CPEP fail to provide them with a safe and sanitary environment, but the long wait times triggered their depression and anxiety.

Former patients air out concerns

All 16 patients or their family members interviewed by News 4 Investigates said CPEP is no longer an option after what they experienced.  

Some of the patients asked to remain anonymous because of the stigma on mental health.

The former patients described CPEP as a drab, cold environment with a lack of chairs and beds, and a shortage of mattresses, linens, and blankets.

A 38-year-old woman from Amherst, who asked to be anonymous, described CPEP as “an impound lot for the emotionally unstable,” that exacerbated her anxiety and depression.

In and out of mental health facilities for most of her life, the woman said CPEP seemed inefficient.

“The second I got in there, I knew it was a mistake,” the woman said. “I went there for help and didn’t get it, and there was nowhere else to go, and I didn’t burden my family with my issues.”

She got admitted to Brylin after leaving CPEP and said she got a room with a bed right away and had much easier access to mental health professionals.

“If you need to talk to someone, there are social workers, there’s help,” she said.

A 26-year-old Lancaster man said that in October he went to CPEP voluntarily at 4 a.m. and was not discharged for about 27 hours. He asked to remain anonymous because of the mental health stigma.

He noticed some significant differences from when he had gone to CPEP as a teenager, particularly fewer workers in the facility. He witnessed several fights throughout the day, including a food fight.

“It was complete chaos,” he said.

While he was on the phone with his mother waiting for a staff member to escort him out for discharge, he said a patient grabbed the phone out of his hands and tried to hit him with it. He missed, but then slammed him on the ground. He was taken to the medical emergency room where doctors determined he had a broken right collarbone, which continues to cause nerve pain.

“After the experience I just had there, I can’t go there for help anymore,” he said. “That is supposed to be a safe place where you don’t need to be on edge all the time if something bad is going to happen to you.”

Jeff Brown and his wife, Laura Shriver-Brown, said their CPEP experience was a nightmare.

Shriver-Brown was with her husband as he was being triaged into CPEP and she said the worker doing intake was complaining about her job. She said she waited and waited for someone to explain to her what the next step would be for her husband.  

Jeff Brown said CPEP felt like a prison and went three days without sleeping.

In hindsight, she thought that was a missed opportunity for someone at ECMC to show her options for her husband after discharge. She said her impression was that choices were made by hospital leaders based on cost and not on how they might benefit patients.

“Like, they didn’t have any resources,” she said. “This is not a solution-oriented business and that’s why I reached out. I reached out because I want people to understand that this affects the whole community, not just our family. These are people that are going back out on the street homeless or go back to a non-supportive spouse. I’m angry, and not at him, but at the situation. But I have resources to help me. Do you know how many people don’t?”

Brown said the door locked behind him once he entered the CPEP milieu, where it felt like a prison.

Once in CPEP, patients cannot immediately leave without a doctor assessment. Patients deemed to pose a significant risk of harm to themselves or others need court orders to leave.

After her husband failed to sleep on the third day, Shriver-Brown, who co-founded a nonprofit senior adult daycare program in Buffalo, said she called every administrator. She was also concerned that her husband was not getting specific vitamins he brought that provide relief for some of his physical health ailments.

She said she was emotionally “falling apart” when a CPEP administrator returned her call.

“She was very professional,” Shriver-Brown said. “I said listen, I have to do the same thing, we take care of senior citizens for our business. You can’t emotionally dive into every client. So, I said I understand you have to separate yourself, but you need to understand what happening here … If your husband was in CPEP for three days without sleep, the most fragile he’s ever been in his entire life, what would you be doing right now? And he magically finally got a bed to sleep in that night.”

That is the only night her husband said he slept.

Michelle Brooks testified at Wednesday’s mental health public hearing in Buffalo, that it was a last resort in April to take her daughter to CPEP, where they were met by “deplorable and inhumane conditions.”

She said both her and her daughter were ushered into a room that had cold air blasting on them from a ceiling vent. Her daughter was in a thin medical gown that did not completely cover her body, so she had to ask for a sheet.

“We were sitting there freezing with air blowing down on us, when three people burst into the room – three males, you know, one of them a security guard/police officer with his very intimidating uniform,” Brooks said. “She was then entered into the CPEP area with the locked doors. She had a long wait time as many others had, some as long as over 60 hours. They are given no expectation as to how long they are going to be there.”

There was urine on the floor. The lights were too bright and the TV was always on. Patients exhibited varying degrees of mental illnesses, and some roamed the room staring at other patients. There were “altercations” between patients and hospital workers.  

All of this made her daughter scared and deeply uncomfortable.

“There is just no way to sleep and you are very vulnerable and fragile at that point,” Brooks said. “It is just like mental suffering.”

Brooks said an ECMC administrator told her that no one should leave the hospital worse than how they came in. But that is exactly what happened to her daughter, who disengaged with her therapist, psychiatrist and family once she was discharged.

“Something needs to happen now to prevent suffering like people in the emergency room,” Brooks said.

ECMC said the CPEP environment is purposely designed the way that it is so that patients do not harm themselves. As for the lack of chairs, ECMC said they have them on backorder.

ECMC officials said they increased security staff in CPEP in 2014, after an employee was badly injured by a patient.

Cummings said gauging wait times, and communicating those to patients, can be difficult. The average length of stay for CPEP patients is about 18 hours, he said.

“It’s a balance between trying to keep them in the milieu calm, and also being completely transparent,” Cummings said. “If you know someone’s going to be there for 16 hours, and they’re saying if you don’t let them out in the next five minutes I’m going to become aggressive – the staff is walking that very fine tightrope.”

Current and former workers at ECMC’s CPEP said poor staffing ratios are the root cause for many of the problems.

Concerns of current & former employees

Current and former workers told News 4 Investigates that inadequate staffing has been a constant problem and creates security risks for both them and patients.

News 4 Investigates spoke with five current and former CPEP workers, including nurses. Current workers asked to remain anonymous because they did not have permission to speak to a reporter, and former workers did not want to be blacklisted from any future nursing jobs.

Two former nurses said they left ECMC because the work became too dangerous, and the hospital’s administration would not address workers’ core concerns on staffing and safety.

“It got to a point where, you know, I worked some shifts as the only RN on my floor,” said a former ECMC registered nurse who worked in CPEP and behavioral health units. “I felt like I could not keep myself safe at work. I felt like I could not keep my co-workers safe at work.”

Another former nurse said she was injured so many times in violent interactions with patients that she felt like she no longer had a choice but to leave the job.

“I felt like at some point I was going to be out permanently,” the former ECMC nurse said. “I wasn’t going to be able to be a nurse anymore. I wasn’t going to be able to take care of my family. It even affected my marriage. It just affected everything.”

The work is dangerous.

A News 4 Investigates analysis of 2019 Department of Labor injury logs for ECMC found 30% of the total missed days of work for all ECMC employees could be attributed to injuries caused by violent interactions with patients in CPEP and the behavioral health units, including unprovoked attacks that involved hitting, scratching, biting, and spitting by patients.

Put another way, more than 70 workers missed about 2,250 days of work that year due to injuries they sustained from violent interactions with patients in the mental health units.

“And the newer staff are extremely scared,” said a former longtime ECMC nurse who asked to remain anonymous.  “You can tell they’re scared, and it’s come to a point where you can’t retain anybody.”

Lona Denisco, an ECMC nurse and New York State Nurses Association union member, said nurses are often managing double—digit patient loads even though ECMC administrators agreed this summer to staff ratios of one nurse for every three patients in CPEP.  

“We come with solutions, we provide ideas, we have presented things for retention and recruitment across the board, incentives to get better staffing, and nothing is ever done,” Denisco said.

Cummings said staffing ratios are not the panacea to the violence and other problems.

“You can have 10 or 12 patients in the milieu total, but two of them can be very aggressive or developmentally disabled, maybe with no expressive language skills or other things like that, and that can drive a staffing concern even though your ‘fully staffed’,” Cummings said.

Cummings said it was frustrating and discouraging to hear employees say they feel ignored.

“I believe that is the way that some staff feel,” Cummings said. “The ones that enjoy their job don’t call your number.”

The staffing concerns boiled over last month when a video surfaced on TikTok showing a contingency of union members confronting ECMC administrators about a plan to fill the CPEP staffing gaps. The union and ECMC are negotiating a new contract.

“I was taking care of 50 people by myself,” a nurse said to an administrator in the viral TikTok video.

The state Department of Health confirmed it is investigating staffing complaints at ECMC’s CPEP, as first reported by News 4 Investigates last month.

ECMC strongly denied that nurses are working with those high caseloads.

“To date, we have been having ongoing conversations with our NYSNA representatives, it is unfortunate that some misinformation has been disseminated on this subject,” the hospital said in a statement responding to the union’s allegations.

ECMC said that it has posted 13 registered nursing positions and brought in six agency nurses on Thursday to work the night shift. In addition, two nursing interns started earlier this month, and they will eventually be transferred to nursing positions later this year.

Mental health advocates said these types of complaints from former patients and CPEP workers have been around for years, which ought to be a signal to decisionmakers that change is necessary.

Advocates want system of care improved

Advocates and mental health workers told News 4 Investigates that CPEP is not consistently providing patients with timely assessments in a safe place, which has resulted in both longer wait times and an exacerbation of mental health symptoms for some patients.

Maura Kelley, a certified psychiatric rehabilitation practitioner and behavioral health peer liaison with Western New York Independent Living, said the complaints from former CPEP patients are not new.

“People are afraid,” Kelley said. “No one wants to go to the psychiatric emergency room, but everything ends up there. If you are not getting the proper care or the preventative care, or you’re put on a waiting list, you’re going to end up in CPEP.”

There is a growing concern amongst advocates that the horror stories could persuade some people to avoid seeking help.

“People need help, especially this time of year,” said Dr. Wendy Weinstein, the adult unit chief at Brylin Hospital in Buffalo. “There needs to be a place where people can have a sense of help and hope.”

Mark O’Brien, commissioner for the Erie County Department of Mental Health, said there is an overreliance on CPEP.

“That should not be the first line of crisis response,” O’Brien said. “There should be a host of other things and we as a system want to make sure we do a better job to get those assets out to people.”

Specifically, O’Brien mentioned the Kirsten A. Vincent Respite and Recovery Center, a first-of-its kind facility that will offer a host of mental health services staffed by peers, including crisis care, under one roof. The center opens soon on Maple Street in Buffalo in the Fruit Belt neighborhood and will be open 24-hours.

O’Brien also mentioned the “Living Room” model crisis centers, which are also staffed by peers.

Diverting people from CPEP is a big challenge, though. First responders and private ambulance companies have been trained for years that CPEP is the location they take patients in mental health crisis.

Adding to the challenge is ECMC’s safety-net hospital status, which prohibits diversion of mental health patients to other facilities when CPEP traffic surges.

And then there are the funding challenges for ECMC and nonprofit organizations that provide mental health services.

Shannon Higbee, the CEO of the not-for-profit, peer-run Recovery Options Made Easy, said during Wednesday’s public hearing on access to mental health care in Western New York, that a lack of funding has made it difficult for nonprofits to market services to residents, educate first responders, and pay competitive salaries in a field that is in a recruitment and retention crisis.

“However, a lack of community and first-responder understanding of the available hospital alternatives has created a systemic underutilization of peer-operated services, where hospital emergency rooms have become a default response to all mental health crisis regardless of available alternatives,” Higbee said. “This cycle can only be broken through developing, fully funding, and appropriately marketing and educating both the public and the providers including first responders on a full continuum of crisis resources that focuses on alternatives.”

ECMC funding challenges

Cummings, ECMC’s associate medical director, said there is huge disparity in national spending on medical health care compared to mental health care.

According to federal data, U.S. spending on medical health care reached $4.3 trillion in 2021.

Spending on mental health treatment and services was less than $250 billion that same year.

Another issue is the Medicaid reimbursement rates for CPEPs.

“Not to be grandiose, but we could take double the funding and find a good way to spend it to meet needs for individuals,” Cummings said.

Overcoming these challenges will take some form of state action.

Earlier this month, Governor Kathy Hochul announced a plan to pump $1 billion in spending on mental health services.

While it is unclear how the plan might benefit ECMC’s CPEP, advocates said the state will likely bring back online some of the inpatient beds ECMC lost during the height of the Covid-19 pandemic.

While there is agreement that more inpatient beds is part of the solution, some cautioned lawmakers to take a more holistic approach that will ultimately benefit the entire mental health network of services.

Higbee, CEO of Recovery Options Made Easy, testified at Wednesday’s public hearing on mental health services, that her organization raised funds in the community, including from the Erie County legislature. But the lion’s share of funding for the Kirsten A. Vincent Respite and Recovery Center came from community foundations, “because the state isn’t funding them at a level that is consistent with the needs.”

As for CPEP, until more people become familiar with alternative mental health crisis services, advocates said it will likely continue to be the default place for residents in mental health crisis.

“That scares the hell out of me that people are going there in their most fragile state and honestly not even talking to somebody for two days or longer,” said Brown, who was in CPEP last year.

If you are in need of mental health services, there are multiple options. Click here to view community resources. Other programs and services can be found by clicking here. If you feel the need to speak with someone about any difficulties managing your mental health, you can call the Erie County Warmline at 716-248-2941 or text 716-392-221 or call the 24-hour Crisis Hotline at 716-834-3131. Spectrum CARES Team can help families and children in crisis, just call 716-882-4357.

Dan Telvock is an award-winning investigative producer and reporter who has been part of the News 4 team since 2018. See more of his work here and follow him on Twitter.