Saturday, August 19, 2006

[Roy] Where have all the psych beds gone?


Since the deinstitutionalization movement in the 1950s and 60s, the number of psychiatric beds in the US has been dropping, coinciding with the psychopharm era, the community mental health center era, and then the managed care era.

There used to be 20.4 public and private psychiatric beds per 10,000 population in the US in 1970, and now there are only around 3.6, a drop of 82%. This compares to 465 general med-surg beds per 10,000 population in 1975, with a current staffed capacity of around 229 (51% drop). In 2003, 5.8% of folks admitted to hospitals from an ER were for mental health and substance abuse problems.

The definition of a "medically necessary" admission has been so eroded that currently you pretty much have to threaten suicide to gain inpatient psychiatric hospitalization. The result of these changes is an inadequate supply of both inpatient psychiatric beds and of community alternatives.

The ongoing debate is whether to invest money in more psychiatric beds or into community services which can prevent the need for the beds in the first place. While the debates continue, patients pile up in Emergency Departments (ED) throughout the country, waiting for a bed to open up somewhere in the state. In Maryland, it is not uncommon for folks to wait in an ED for 3-5 days before being transferred out. It is particularly problematic for kids, seniors, developmentally disabled folks, and the uninsured.

In Louisiana, their previous shortage has grown worse since Katrina, resulting in serious backups in the ED.

Times-Picayune: "The problem is not confined to the New Orleans area. Joseph Miciotto, administrator of the LSU Hospital in Shreveport, said the emergency room there has had up to 21 psychiatric patients awaiting admission at the same time, creating potential safety problems for patients and health workers."
USA Today: "And estimates also suggest that only 22 of 196 psychiatrists continue to practice in New Orleans, while the number of psychiatric hospital beds has been sharply reduced: as of June 14, the authors said, there were only two psychiatric beds within a 25-mile radius of New Orleans."

I have noted a reversal of this trend in the last few years. States are starting to add beds, mostly because of outcries from mental health advocates about long waits in EDs.
Kansas City Nursing News: "Over the last 15 years, the number of adult psychiatric beds has steadily decreased in the Kansas City area. Today, there are about 450 beds in the community, a 65 percent decrease from 1990. Based on national and regional data, the Kansas City area should have 600 psychiatric beds."

If you have info to share about what is happening in your state, we welcome your comments.