While hospitals generally find a way to make space for patients with medical illnesses, all too often, psychiatric patients are turned away because the hospital can't find a bed for that patient. Sometimes the patient can be stabilized on an outpatient basis, but other times, disturbed patients may commit suicide or harm others if turned out of the hospital when they need inpatient treatment.
Consider the experience of Virginia state Sen. Creigh Deeds, who brought his son to an emergency department last year because of concerns about the son's erratic behavior. Deeds was able to get his son held for examination at the hospital for six hours, but when a bed couldn't be found for his 24-year-old son Austin Deeds, the hospital sent Austin home. Within 24 hours of being released, Austin attacked his father with a knife then killed himself.
How often are acutely ill psychiatric patients discharged from hospital emergency departments? More often than most hospitals would like to admit. And state hospitals are increasingly losing their ability to serve as a backstop to private hospitals. Mental health advocacy group The National Alliance on Mental Illness estimates that states cut mental health budgets by $1.6 billion between 2009 and 2012.
Sadly, we're at a point right now in most states where even patients that are lucky enough to get a bed may wait many hours or even days in the emergency department as boarders before they can appropriate treatment. In other words, hospital psychiatric care is in crisis, but little is being done to address the problem.
So why, given the obvious need, is psychiatric bed availability contracting despite the fact that incidence of psychiatric illness has not declined? One major reason for this is financial. Private hospitals invest big bucks in service lines with a big return, such as birthing centers, but not so much on psychiatric care. I'd also argue, though most hospital executives would deny it, that many health leaders simply haven't paid much attention the overwhelming size of the problem, and are playing a game of NIMBY (not in my back yard) with psych patients.
As a piece in Health Leaders notes, there are some solutions that can relieve some of the pressure. For example, in May 2008 three large hospital systems serving the Columbus, Ohio area joined to form the Franklin County Mental Health Collaborative.
The collaborative agreed to a simple protocol, in which the patient who has been waiting the longest for psychiatric inpatient bed gets the first one available, no matter what where it is located. The program seems to have been a success. In May 2009, there were 400 psychiatric patients in Franklin County EDs, when wait times for a bed could number up to six days. By October 2013, the average length of stay for psychiatric patient needing inpatient bed was down to 19 hours despite an increase in psych patients seeking care.
This is just one of several strategies being successfully implemented nationally. But the reality is most hospital systems aren't cooperating or looking for new solutions when it comes to psychiatric care, probably because no one is going to throw them a parade for simply treating psychiatric patients with as much concern and thoroughness as they would any other patient.
But the time has clearly come for not only hospitals, but the mental health system that feeds into those hospitals, to have serious conversations about how they can better address the needs of the psychiatrically ill when they need inpatient care. If we don't want to see more patients die, it's time to take action.