Bedbugs in the waiting room

At the 2011 annual meeting of the American Psychiatric Association, a series of case reports were presented showing how bedbugs can be responsible for a wide range of emotional and mental symptoms and can cause significant impairment, even leading to suicidal behaviors and hospitalization. Psychiatrist Patrick Ying from New York University said that bedbugs can affect a broad variety of populations. He said the “impact has been underappreciated” and that “bedbugs can have an impact on the psychological health of otherwise healthy people.” They also “can also affect more vulnerable populations, including patients being treated for serious mental illness that can lead to serious decompensations.”

A couple of weeks ago a fellow CMHC CEO, asked me if we had an outpatient bedbug policy. We didn’t at the time. We had a residential policy that seemed to work well and we didn’t see a problem in our outpatient offices. If a bed bug was suspected in outpatient, staff would call in our maintenance department to validate the infestation and then they would treat the area or call in our exterminators.

Since then, however, we have had a few clients come into our outpatient offices with obvious bedbugs on them. Occasionally a client will report or complain about bedbugs. Most of these people come from a local public housing project, a homeless shelter, or a nearby residential alcohol treatment program. Our therapists and case managers are concerned about getting offices infested and taking the insects home with them.

Our front desk staff are also concerned that they will infest our waiting rooms and spread to other clients who use that furniture. In January I read how an infested emergency waiting room was shut down for several hours at St. Mary’s Hospital in Richmond Virginia, after a single patient was determined to have bedbugs.

In the past many centers would send folks with head lice home right away with instructions on how to treat the condition and a prescription or bottle of medicated shampoo. As for the bedbugs, we are less sure what of the best thing to do. We can make home treatment part of our skills training program for some clients, but many are at the mercy of their environment. We have talked about an isolation office or special waiting area, but that sounds discriminating since we really do not know who has them and who does not.

Some centers are banning all patients with bedbugs from outpatient facilities. Some see them offsite or in a more controlled setting. Others require that the client’s home be free from bedbugs before allowing them into center facilities. Of course there are also some staff members who become extremely upset by even the thought of carrying bedbugs home. We’d like to address this issue in a humane and reasonable way without unduly stigmatizing our clients or minimizing the adverse impact on our staff.

What are you doing to respect everyone’s rights, health, and dignity?