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.

10 comments:

bgp said...

"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."

Here where I work (PA), suicidal ideation sometimes doesn't even get you in. We have plenty of folks who threaten suicide in order to get a bed and food, so our job also becomes that of "lie detector." There definitely are shortages of psych beds where I work and admitting malingerers steals beds from more legitimate patients (not to say that malingerers are sick; of course, they are, they're just likely not as acute).

bgp said...

that should read: "(not to say malingerers AREN'T sick..."

drytears said...

My first stay in a psych unit was because of my very sersious suicide attempt that had me on a ventilator in the ICU. The second time I was admitted it was because I had thoughts of suicide with a plan and the means... I was so scared they wouldn't admit me, I wanted to get better, the on call psychologist wanted me to go home, but the psychiatrist from the psych floor said it would be a good idea to admit me.

Funny thing though, the psych unit I was on had 13 beds. We are the smallest psych unit around. The most people there when I was there was 8, and that was only for a couple of days.

The largest psych unit, around ended up getting filled during my first stay, and then soon the second largest was filled, and even though we aren't the next largest we were a lot of times closer than the other ones... and the nurses were scared we were going to get a bunch of new admissions, we got none!

So I guess I never realized there was this sort of problem.

On the Same Page said...

You can read about CA Proposition 63, which was passed in 2004, here. I have, however, seen no increase of services, availability of I/P beds, services to the homeless, and certainly no reduction of mentainlly ill patients in jails in this county.

Initially was going to answer your question with a link to the ACLU website, as well as some major insurers, but I thought better of it. Or maybe I didn't.

Dinah said...

Re: New Orleans, I believe there are 20 beds (down from 300 post Katrina, serving half the pre-storm population). Good article, though very disheartening, about mental health issues in NOLA:
http://www.time.com/time/nation/article/0,8599,1221982,00.html

On the Same Page said...

The State of CA announced today that Prop 63 has generated, by taxation (it taxes every person's income that exceeds $1,000,000), a half-billion dollars more than originally expected. CA and 10 other states (including Maryland) have joined a Network of Care that lists MH services by county.

Prop 63 was extensively campaigned as the Prop to bring MH services to the "underserved" and help end homelessness. I don't mean to be cynical, but I am not holding my breath.

Sarebear said...

Uh oh. Surplus money = every other possible and not possible agency, interest, etc. is going to want a piece of that surplus pie . . .

ClinkShrink said...

Love the Network of Care brochure---but where are the services??? Only two out of 23 Maryland counties are listed.

Sandra said...

There's a severe and worsening bed shortage in Canada too, with no replacement services or facilities to treat those severely and persistently mentally ill who are unable to take care of themselves. Instead mental health, empowerment and self-determination are buzzwords, and the new treatment trend is peer counselling instead of TMS. Which, of course, also saves the system a lot of money.

Forum thread on Canadian woes. We're no socialist paradise up here. People are refused care routinely.

Anonymous said...

The pic here seems to have disappeared? --dinah