Ohio has 'critical' shortage of psychiatric hospital beds
Hamilton Journal News (OH)Mar 01, 2015
"Coverage does not equal access," said Dr.
In addition to the
In the U.S., one in four adults has a severe mental health need, but only a third of the affected population seeks out treatment.
"Psychiatric illnesses are the No. 1 public health problem in the U.S.," said Dr.
But the national cohort of about 49,000 psychiatrists is aging -- ranking as the second oldest group of physicians -- and not as many young physicians are opting to enter the specialized field, according to the
In 2012, slightly less than 4 percent of graduating students chose psychiatry, according to Dr.
"There are too few people to take care of the overwhelming demand for services; it's a national crisis," Keck said.
"The difficult part was when he was released there weren't many psychiatrists taking new patients," Pastore said, who found one through a social worker.
Reasons for a shrinking pool of psychiatrists include a high rate of student loan debt with one of the lowest mean incomes in medicine and low reimbursement rates from insurance payers, Keck said.
"There's a relative fiscal disincentive," Keck said. "The whole reimbursement model has been skewed toward procedures. (In psychiatry) you're billing for time spent with individuals embarking on evidence-based treatment plans. The value of that has been gradually marginalized by payers."
Shortage of beds
Across the nation, the rate of inpatient psychiatric beds has plummeted to 1850 levels. There were over 558,000 public psychiatric beds in 1955 -- which declined over 92 percent to around 43,300 beds by 2010, according to 2012 data from Treatment Advocacy Center.
"To improve the care of people with severe mental illness, states need to improve their civil commitment laws and restore psychiatric beds to meet the needs of the population with severe mental illness," Mondics said.
There are about 85 public and private inpatient psychiatric beds available in
Those beds are spread out across
Fewer dedicated psychiatric beds means unintended consequences of more patients turning to emergency departments for care, higher rates of homelessness and more mentally ill in jails and prisons, according to Treatment Advocacy Center.
At
The
Romanello said the psychiatric unit at Fort Hamilton usually has 12 patients admitted. He said there's not enough staff to have all 20 beds filled.
Romanello said a crisis worker acts as the "key driver" to finding the patient an open psychiatric bed at nearby hospitals, or across the state, if Fort Hamilton is at capacity. He's sent patients as far as
Romanello said a patient awaiting transfer has an average stay of six hours in the ED.
"It requires the devotion of a nurse to that patient; it ties up resources," Romanello said.
There are six state psychiatric hospitals across
There are about 1,065 beds available at the state hospitals, and they run at 90 percent capacity.
"We are the safety net for the state of
Pastore said about three years ago her son was hospitalized in Fort Hamilton's psychiatric unit and eventually moved to the state's mental hospital in
"In the beginning, he didn't believe he was ill and didn't want to take medication," Pastore said.
Pastore's son has been taking medication for about a year now after spending five weeks at
"He had gotten so very sick and scared of what was happening," Pastore said. "He had a very good experience there. They set him up with a good plan for home health."
Keck said the mental health needs vary greatly -- from mood disorders, bipolar disorder and depression, traumas, eating disorders, anxiety and substance abuse.
Romanello said it's estimated that a fourth of emergency department visits have an underlying psychiatric concern.
"The iceberg is bigger than we even know," Romanello said. "As each hospital looks to serve their community; they should consider mental health as a priority."
Shortage of providers
There are more than 96.5 million Americans living in shortage areas for mental health providers, according to a
There are about 4,000 designated mental health professional shortage areas in the U.S., with about 125 in
The designation is bestowed for a variety of reasons, including for geographic areas, low population to provider ratios, low-income or
In
"The designation ... is intended to allow them eligibility for recruitment and retention programs," said
Marc Bellasario, CEO of Primary Health Solutions, said his agency got the designation automatically due to being a federally-qualified health center. It helps with recruiting people to the area by offering some loan forgiveness.
Hurst said the state hospitals also have a hard time recruiting and retaining qualified staff. He said in the last three years they've hired more allied health professionals, such as psychiatric nurse practitioners and physician's assistants, to fill in the gaps.
"We were having substantial problems with recruiting and keeping psychiatrists," Hurst said.
At
"Historically it has been difficult to recruit because there's such a severe need across the country," Romanello said. "Technology stands to improve the situation. Telepsychiatry is beginning to robustly develop."
Romanello said the
Solutions
The Treatment Advocacy Center said the increased use of community health centers and outpatient services will continue to quell the demand for inpatient beds.
Keck agrees that providing "good, quick" access to outpatient treatment options can help a patient avoid the later need for hospitalization.
"You always want to treat a mental illness as early as possible," said
Primary Health Solutions contracts with
The behaviorist assesses the patient's need for therapy or to see a psychiatrist. Bellasario said they also now screen for depression and substance abuse problems in an attempt to catch a problem before it balloons into a crisis.
Pastore said while her son has a high school diploma and college degree, he's not been able to work due to his illness. He receives supplemental security income and disability.
Pastore said in recent years she and her husband have become advocates for their son through education and resources from
"If you don't have an advocate, you're not finding help," Pastore said. "Just like any other illness ... when your family member gets a diagnosis you help them."
Another safety net to improve a patient's likelihood for success after hospitalization is a group home setting to step down to, said
Reese said he works with clients before and after hospitalization to coordinate placement in group homes in
"You hear talk of providers wanting to build more facilities and beds but until then ... it's kind of a juggling act," Reese said. "
"It's a time to focus on you starting over," Reese said. "If you're at a hospital and have nowhere to go. You don't have to worry about where your next meal is."
Keck said a mentally ill patient is at their greatest risk for suicide within 30 days of discharge.
Reese said a stay at Great Miami Services ranges from one to four months before moving to a more independent setting like a group home.
Pastore said her son is living at home now due to what she says is a lack of quality, supportive group homes in the area. She said there's also little access to therapy or programs for life and behavioral skills.
"There's not the next piece of how to manage your life," Pastore said.
___
(c)2015 the Journal-News (Hamilton, Ohio)
Visit the Journal-News (Hamilton, Ohio) at www.journal-news.com
Distributed by Tribune Content Agency, LLC