Massachusetts state authorities in US have found that psychiatric patients receive a raw deal in emergency rooms (ERs) in hospitals . They are punched and hit or held in restraints for hours.

One patient died while in restraints, and a patient's arm was broken as a nurse forcibly removed his pants.

These cases are a sign of the growing strain on the state's overcrowded emergency rooms, doctors, nurses, patients and state officials said after investigating as many as 21 complaints in the last 18 months.

They also conceded there was a very real shortage of services for the mentally ill and inconsistent training of harried ER staff.

Emergency rooms can be battlegrounds. They often are the last resort for psychiatric patients in crisis -- some patients are so out of control and aggressive that mental health facilities will not take them -- and ERs have responded by creating "safe rooms" to handle such patients and on occasion calling in police for help, according to interviews with 20 doctors, nurses, patients, and hospital administrators.

ER staff give psychiatric medications but are not trained to provide comprehensive psychiatric care, they said. And many of these patients stay in ERs for days without proper treatment because of backlogs in psychiatric facilities, creating potentially volatile situations for those patients, staff, and other patients. Hospital officials said nurses, too, have been injured in confrontations, and patients contend that they are humiliated by policies like the one requiring them to undress.

Documents from the Department of Public Health -- which conducts investigations when patients or relatives complain or hospitals themselves report problems -- show that investigators cited 11 hospitals for a range of problems. Those cases include:

A blind, disabled patient who went to Lawrence General Hospital in April because he was suicidal. Hospital policy then required psy
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