Saturday, November 04, 2006

Psych beds dropping like fish

According to yesterday's Science Magazine, we may lose the availability of sustainable fisheries by 2048 (see Scientific American: Overfishing Could Take Seafood Off the Menu by 2048). The article predicts total collapse of all world fisheries by 2048. "Total collapse" is defined as 90% depletion since the 1950s.

[prepare for non sequitur]

We have also been rapidly losing the availability of psychiatric beds for folks in need of acute inpatient hospitalization for mental health problems like major depression, bipolar disorder, and schizophrenia. In Where have all the psych beds gone?, I deplored the massive loss of inpatient psychiatric beds over the past 40 years or so. We used to have 20.4 beds per 10,000 population, and it is now down to 3.6. The numbers are now at about 18% of what they were previously. Another 8% to go before the U.S. hits "total collapse." Of course, there has been an opposite trend in forensic psychiatric beds, but I'll leave that for Clink to blog about (also see Hot Potato).

"Holy mackerel!" is right. People are boarding for days at a time in Emergency Rooms all over the country, waiting for a bed to become available. So, what's the current state of affairs? Check it out...

Pennsylvania State Hospitals Cutting Beds: NAMI President, Dr. Suzanne Vogel-Scibilia, as well as other citizens, petitioned the governor to halt bed closures. "'We ask this because of current inadequacies in community resources and the lack of a statewide comprehensive plan for closure and placement,' the petition reads."

Florida Community Loses 16 Beds: Citrus County now has no psychiatry beds. Hospital officials say the beds were not needed. "But mental health advocates say Florida faces a shortage of inpatient psychiatric beds. The state received the lowest score possible in terms of access to inpatient services, according to a recent study by the National Alliance on Mental Illness. 'There are about 3,000 more beds needed in the state,' said Sue Homant, executive director for NAMI Florida. 'My personal guess is the number is even higher than that.'" ... According to NAMI's Report Card, Florida scored an F in Infrastructure, 48 out of 50 in per capita spending on mental health (a whopping $37.99 per person), and was number 15 in suicide rank. Florida is floundering.

Ohio Gaining Beds: "Mental health professionals say more beds are needed since a number of hospitals with psychiatric services closed or cut beds in the past decade."

Connecticut ERs Filled to the Gills: 2-weeks in ER awaiting a bed is common [treating them in a unit takes less time than this].

Let us know what is happening in your state (or country).


jw said...

This, local to me, seems to be indicative of Ontario's psychiatric bed situation:

In other words, some good news amid the bad ... not much good news though.

Canada's cost per patient is a lot lower than the US, that should be obvious to all. The same applies to medicine and drug costs.

Here's a piece of my household budget showing our drug costs, ($ Canadian):

Drug Cost Per

R Codeine $13.69 120
Propanalol $13.39 180
Seroquel 100 $259.98 180
Carbemaz $22.28 180
Seroquel 25 $101.58 180
PatVIT $6.89 90
EyeDRPS $23.44 120
LaKota $40.20 120
Aspirin $4.39 200
Tylenol $4.99 200
Ibuprophen $6.99 200

This creates a situation in which there may well be more money available for beds ... hard to say though.

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Dinah said...

Perhaps we could house psychiatric patients in empty fisheries?

Dr. A also wrote about this and it was in the NY Times. No more fishies?

Gerbil said...

Money for mental health services is being cut all across California, although there was a citizens' initiative to get more money to the county MH systems and the money is finally available. However, "the system" is so terribly mismanaged that even this money (which came from an extra income tax on the extremely wealthy) isn't going to do much. There aren't enough beds now, and there aren't going to be more in the near future.

To make matters worse, the major psychiatric hospital in my area, which receives the bulk of emergency admissions, can't provide any medical services. Prior to admission, one must receive medical clearance at another hospital--and any medical treatment during one's stay must be done elsewhere as well, if at all. Crazy.

Anonymous said...

I live in the UK. Our mental health services have been the Cinderella services of our health service for years. Recently there has been extra investment in Assertive Outreach, Early Intervention and Home Treatment Teams, together with an increase in respite houses, accompanied by some reduction in beds to reflect the increase in services for managing crisis outside hospital.

However, acute (general) hospitals are in crisis, so the money is being taken from the psychiatric services to pay for general services, with the result that cuts are being made again in both day services and inpatient beds.

Most of our psychiatric beds have more than 100% occupancy, with many patients being sent on leave when not ready for it to make room for others. Hot-bedding is common.

Sarebear said...

do they make a wet fish plop sound when they hit the floor? Cause I'd think a dropping bed would sound more like a thunk . . .

NeoNurseChic said...

You covered my state as you touched on Pennsylvania. Hope the Governor does actually halt bed closures as I'm planning to vote for him on Tuesday, and I also feel this is an important issue! I haven't clicked on the link there because I'm tired and just checking here quickly before spending a little time studying for an exam before going to bed and working another 12 hour shift tomorrow. It sounds really bad to me when I say that I worked 24 hours in 2 days. So instead I'll just say that I spent 12 hours working today and will work another 12 hours tomorrow. I'm spending half my life these 2 days at the hospital....NOOOOOoooooo - at least I only work 3 days a week! ;) (Otherwise I'd be taking up one of those psych beds - based on the situations we've had lately! I was verbally attacked last weekend and today another nurse was threatened...I swear they're dropping us like flies - and security is getting to know all of us very very well....and I'm sure social work is having fun reading 3 page social notes like the one I wrote! Just tired of working in an unsafe environment from time to time...)

Anyways - will be interested to see if Governor Rendell does indeed halt the bed closures. I've always liked him, and he definitely has my vote for governor again. Rick Santorum on the other hand? Nay... Of course, to vote this year - I'm still registered in the county where my parents live. That means that after work tomorrow night, I have to stop here and feed the kitty/get an overnight bag. Then I'll head to my parents' house around 9 or 10pm. I'll vote in the morning on Tuesday and then get to Philly by 10am for a psychiatry appt of my own. Then off to my own hospital for a neuro NP appt and then to the library to study until an exam at 7pm. Election day better be worth it since it would be much easier for me to sleep in my own bed tomorrow night and just not have to get up as early!

Sorry - these are the ramblings of a super stressed out and overtired neonatal nurse. After working 16 hours with a crticially ill baby on Friday, I slept all day yesterday except for about 5 hours...but then today wore me out again and I'm sort of lacking the energy to go back again tomorrow. Especially if I have to deal with yet one more social situation from he11....

Glad you got PA covered!
Carrie :)

Julie, RN said...

I feel fortunate that our community hospital has adult, adolescent, and geriatric psych units (28, 8 and 18 beds, respectively), and is going strong. Often, we are filled to capacity and patients are held on medical floors until we have a vacancy. The average stay is about 12 days with us. If the patient is not medicare, the precertification process is tedious, and the initial 3-4 days granted is merely a blow-by.
We, too, require medical clearance prior to transfer, as we are simply not equpipped (or staffed) to handle the more intense medical problems; this also is necessary for patient safety due to the nature of some patients' psychosis. We are finding that (esp. on the gero unit) the greater acuity of health issues we are seeing are requiring us to handle both mind and body illnesses; some program aspects need to be tweaked to address this issue.
Placement and outpatient care are hot topics. The county MH/MR offices will not accept referrals if the primary dx is 'dementia' of any type. Many LTC facilities would prefer not to accept a diabetic with leg ulcers who requires physical therapy if she also is a paranoid schizophrenic...
Involuntary commitment to the state hospital is not always an appropriate action for those needing more long-term treatment beyond our walls, and rare is the person who willingly would accept placement there.
I guess our problem is, what to do with them once we're through. It would be great if there was enough money to go around to build more programs for sub-acute psychiatric treatment/housing, especially for the growing population of the elderly.

Sandra said...

In BC, Canada, the only tertiary care hospital (Riverview) is slated for closure in two years. Over the past decade they've downsided 800 beds; what's left are the most serious cases who need locked wards. Those 500 or so beds are to be all closed in two years.

With no new community facility, no ACT program, no special needs housing, and inadequate access to existing care.

Chronic severely ill patients already have an impact in acute wards, as Riverview refuses to accept new patients, there is nowhere for the hospital to send them for treatment. Meanwhile community Mental Health Teams have two-month waiting lists to access services.

Politically, it's rarely spoken about, although Premier Campbell did admit "deinstitutionalization has been a failure" in a recent speech.

Long term care tertiary facilities have been closed down all over Canada in the last 15 years or so. The homeless numbers, and imprisoned numbers, are way up.

jw said...

SANDRA: Yeah, I know. Here, they're going to close RMHC St. Thomas in a few years.

What do they intend to do with the 50 some odd lifelong closed ward people? There's no place to send them.

What do they intend to do with the 60 some odd post-lobotomy people? There's no place to send them.

What do they intend to do with the 20 some odd severely psychotic placed under court order people? There's no place to send them.

On and on it goes.

Sarebear said...

This is so frustrating. I think the Gen X and Y'ers, and on and on, have been raised in such a me me me culture, and materialistic, and stuff, that they don't even THINK about these sorts of things. In 20 years, they'll start to be the ones in power, maybe, except the even huger elderly population by then might have a greater sway, too . . .

Anyway, I think it's a cultural problem at large, that people just assume there are services, when in fact the situations with these things have been getting worse. I wonder if at some future point, there will be a sort of critical mass reached, and the amount of crime or other problems related to the discharge and no solution for these people will impact even those who like to pretend such things don't exist.

Sad. Just plain sad. I'm hoping to get to a point where I can advocate for more change; my conversation w/my state's governor and director of health and human services a while back was a start. Apparently the federal govt here in the US cut funding a few years ago, which resulted in a 9 million shortfall here in the state of Utah for some mental health services, and severely decreased and cut off access to such for MANY.

Gotta figure out the next step on pushing for change on that, but anyway, these trends are SAD. Although they help light my fire to do something about it, lol.

NeoNurseChic said...

Unfortunately, it started back before this gen X'er was born. (Well - sometimes they say I'm in gen X but who really knows...) Ronald Reagen was responsible for emptying out and closing down a number of the institutions - spilling the mentally ill out into the streets to end up homeless or imprisoned...

I'll never forget touring the institution we went to when I was at UPMC in Pittsburgh. I wanted to cry. And in fact, I think I felt like there was this deep emptiness in my heart that just would not go away.

Same thing when I did my clinical rotation at a psych hospital in northeast Philly. First off, it was the worst rotation of all my nursing school career as the clinical instructor made me cry in evals and then demanded to know why I was crying. Suffice it to say - I didn't feel she should be working with the emotionally fragile... But anyway - the staffing was very sparse... Nurses? 2 per unit, if I recall correctly. What are 2 nurses and maybe 1 MHT gonna do? Frankly - it was very sad. Walking around there just gave me such a sad, empty feeling - whole parts of the hospital not being used because they couldn't hire more staff. Parts being slated for closure because they were firing those staff due to inadequate funds. When I did my rotation on the geriatric unit, there were adults there who should have been on the comorbid unit....they were "losing their minds" (no pun intended...) stuck on the geripsych unit when they didn't belong there. But the comorbid unit was shut down. It was a nightmare.

And it certainly did not serve to draw me, the upcoming heatlh care professional, into the field. Simply because I saw no hope. I saw no chance for change. And just overworked, overtired nurses who had their hands more than full, working in rather unsafe environments.

But here's to hoping it will get better someday...

Sarebear said...

I didn't mean that that's the generation that beds started dropping, I meant that these generations and on are just so self-focused (well, every generation is to a degree), so, instant solution/gratification to everything, that they just don't THINK about others, at least alot of them don't.