The state’s mental health advocate yesterday filed suit against the state, seeking to stop the practice of holding psychiatric patients in hospital emergency rooms “for days on end” without treatment.

H. Reed Cosper, the mental health advocate, is asking Superior Court, Providence, to prohibit the detaining of mentally ill people against their will in any place other than a licensed psychiatric facility, or to require that such patients be placed in one within 24 hours.

Cosper’s lawsuit strikes at a problem that has bedeviled the health-care system for many years — and was also the subject of a suit by Cosper six years ago. Patients in psychiatric crisis arrive at emergency departments of community hospitals. When doctors determine that a patient is a danger to himself or others, the person can be held against his or her will. But frequently there are no psychiatric beds available, so the patient stays in the emergency room until a placement is found. The patient is kept safe but does not receive treatment for the psychiatric illness.

“These involuntary detainees are held for days on end without the privacy, dignity, individualized treatments plans and access to inpatient care in a licensed psychiatric facility guaranteed by the Mental Health Law,” Cosper’s suit states. It calls such detentions “an arbitrary and capricious exercise of state power” and notes that those who are detained are most frequently those without health insurance.

Hospital emergency rooms are “not medically appropriate” for psychiatric patients; detention there delays recovery and “can reasonably be expected to aggravate some patients’ mental illness,” the suit alleges.

Although it is private hospitals that keep such patients in the emergency room, Cosper is suing the state Department of Mental Health, Retardation and Hospitals because the department is responsible for mentally disabled people. He faults the department for not providing enough beds for them in psychiatric hospitals.

Cosper also alleges that since March, the state has illegally refused treatment to out-of-state residents. Mentally ill people passing through the state cannot get a state-financed bed, and instead wait in the emergency room until someone comes to get them, he said, a practice he called “inhumane.”

Ellen R. Nelson, director of the state Department of Mental Health, Retardation and Hospitals, had not yet seen a copy of the lawsuit late yesterday, and declined to address its specifics. She agreed that the system is in trouble, but said she has a plan to fix it, by opening a psychiatric stabilization unit at Eleanor Slater Hospital next year and increasing the capacity of the hospital’s forensic unit. Her focus, however, is on enhancing services in the community rather than increasing inpatient beds.

Asked whether Cosper’s suit might be a catalyst for faster change, Nelson said, “I don’t think so.” She said she would prefer to deal with individual cases as they occur, tailoring a treatment plan to each patient. “Any time there’s an individual patient we’ll do whatever we need to do,” she said. “I would pledge to work with anybody in the private sector or anybody in the hospitals. … If a patient gets stuck in an emergency room, my question would be, ‘Why didn’t the hospital admit them?’ ”

Before 2001, Cosper said, emergency psychiatric patients who could not find a hospital bed in the community were held at the state-run Eleanor Slater Hospital. After that policy ended and emergency rooms filled up psychiatric patients, Cosper filed suit against MHRH. The department agreed to contract with Butler Hospital to take patients in “holding status.”

But that plan was never part of a court-enforced consent decree and, in Cosper’s view, the state never fully addressed the issue. “Now it’s six years later and the problem is worse,” he said.

In March, according to Cosper, the state moved the contract for emergency psychiatric patients from Butler Hospital to SSTAR of Rhode Island, paying 30-percent less than the previous contract. “MHRH knew at the time it contracted with SSTAR RI that demand for state beds would consistently exceed the supply available,” the suit alleges.

Recently, Cosper said, emergency room doctors and social workers from around the state have urged him to take action. “The emergency room doctors came to me and said, ‘Please, pull the trigger. We’ll help you’ ”

Elizabeth V. Earls, president of the Rhode Island Council of Community Mental Health Organizations, said she welcomed the suit. “More and more people are being held against their will in an emergency room,” she said. “What does it take to expedite a solution?”

U.S. Rep. Patrick J. Kennedy also applauded Cosper for filing the suit. In a statement, Kennedy said he had visited emergency rooms and was “alarmed” at the number of mental-health patients being held there. “Not only were they taking beds away from other patients, they were not being given proper treatment …. The State of Rhode Island is failing its responsibility to provide health care services to patients with a mental illness or substance abuse problem….”

Jeff Neal, spokesman for Governor Carcieri, said that MHRH is designing “a system of care” focused on community-based treatment. But, he said, “This new community-based system of care can’t be implemented immediately. Until it can be implemented it is up to everyone, including the hospitals and others in the system, to make the current system work.”

ffreyer@projo.com