CJUS 630 The Psychiatric Bed Shortage A National Crisis ESSAY 2021.pdf

CJUS 630

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Abstract

Beginning in the 1960's, the inpatient psychiatric bed shortage for treating individuals with

severe mental illness has been a crisis. Today, the crisis remains more strained than ever due to

healthcare cost cuts, the COVID-19 pandemic and strict policies. This paper will discuss the

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The Psychiatric Bed Shortage: A National Crisis

An Introduction to the Crisis of the Psychiatric Bed Shortage

Perhaps one of the most overlooked crises today is the major shortage of inpatient

psychiatric beds for those in need of treatment due to serious mental illnesses. According to a

study published by the Treatment Advocacy Center (n.d.), it is estimated that there is a need of

18.2 beds per 100,000 in Virginia. The same study shows that the United States as a whole has

reached an all-time low at having an average of 12 available beds per 100,000 persons. This is an

extreme crisis to those in critical need of beds, as they are forced to wait days to weeks and

sometimes months in jails, unequipped hospitals and for some - they remain homeless. As the

nation struggles, the number of those in need of psychiatric beds and mental health treatment

only continues to grow. Having the correct access to an inpatient psychiatric beds and medical

treatment could be the difference of life or death to a suicidal teenager, or a severely depressed

the knowledge of the bed shortage. In addition to increasing knowledge of the issue, there is a

new registry that states can use to look up the availability of beds, of which 23 states have

already began using. This paper will discuss the history of the psychiatric bed shortage, the

difference between state and private hospitals, policies that address the situation, how this critical

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bed shortage impacts those suffering from a severe mental illness as well as the cost impact on

taxpayers and include a Biblical worldview point of view of the crisis.

Policy Organization website (2019) states, "public revelations following World War II that most

programs, such as social security, Medicaid/Medicare, during the 1960s. These programs

provided support using federal funds for mentally ill individuals who lived within the

community. However, those that were committed to state hospitals were not eligible for any of

these federal programs, resulting in an incentive for state hospitals (relying on state funds) to

discharge a multitude of persons transferring the cost of their care from state funds to federal

funds (Shortage of Psychiatric Hospital Beds for Mentally Ill, 2019). In addition to forcing

patients out of hospitals and federal regulations making it increasingly difficult to be re-

hospitalized, influential figures such as Dr. Thomas Szasz stated that mental illness was a myth;

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author of One Flew Over the Cuckoo's nest, Ken Kesey argued that "being hospitalized was itself

causing the patients' mental problems and that patients would be much better off if simply

discharged" (Shortage of Psychiatric Hospital Beds for Mentally Ill, 2019).

Worsening Psychiatric Bed Shortages Nationwide,” "combined with years of mental health care

suicide during the past 30 days" (Rapoport, R., 2020). The repercussions of a pandemic have

made the symptoms for those with severe mental illness skyrocket, with patients now sicker than

ever before. In August of 2019, Virginia Governor Ralph Northam, signed a temporary executive

order to stop admissions into psychiatric facilities in an attempt to stop the spread of the

Coronavirus, in addition to governors all around the nation repurposing psychiatric beds for

those sick with the virus (Rapoport, R., 2020). Not only are governors demanding using these

critical beds for COVID-19 patients, but they are also forcibly shutting down psychiatric

hospitals to reuse for the same reasons. While treating COVID-19 patients and stopping the

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spread of the virus is a major step in ending the pandemic, what about all the patients suffering

with severe mental illnesses that cannot get help? The lives of these individuals matter just as

much as those that have been infected with the virus and something must be done to get them the

help they so desperately need. Meanwhile, psychiatric hospitals in Massachusetts have been

somewhere in the state" while today, there are a third less beds, and finding a bed for an

hospitals (Russakoff, M., 2014). In the same study, it was found that "in 2009, 3.1% of all

persons aged 18 or older with any mental illness received in-patient psychiatric care, whereas

6.8% of those with serious mental illness were admitted to hospital" (Russakoff, M., 2014).

According to a 2016 article, Medicaid is not only the "largest payer for behavioral health

services" but they are also in the works of becoming the first to build stand-alone psychiatric

hospital. This is a major breakthrough for those that are covered for Medicaid, and also cuts the

wait time for those stranded in the emergency rooms of general hospitals (Evans, M., 2016).

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Kendra's Law does two things: (1) "it allows courts to order a certain group of to order a certain

for living in the community" and (2) "allows judges to order the recalcitrant mental health system

to serve people with serious mental illness, rather than cherry picking the easiest to treat for

admission" (Kendra's Law Overview and Summary of Results, 2019). Prior to Kendra's Law, it

was required for these particular individuals to refuse treatment resulting in dangerous behavior

in order to receive treatment. Families of these individuals felt the law should prevent dangerous

behavior, rather than require it for treatment (Kendra's Law Overview and Summary of Results,

orders, despite greater histories of violence, were four times less likely to engage in future

violence than those in a control group (Kendra's Law Overview and Summary of Results, 2019).

According to the Mental Illness Policy Organization, Kendra's Law has miraculously proven to

be successful in all of these areas:

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HB 886 is an expansion to the current protocol; HB 886's primary goal is to provide improved

quality care for those patients seeking inpatient psychiatric services across the state of Virginia.

Prior to HB 886, hospitals had the right to refuse treatment based on toxicology reports,

however, with this bill passed the on-call physician must consult with either a clinical

toxicologist or Certified Specialist in Poison Information to devise a treatment plan based off the

toxicology reports (Legislative Information Center, n.d.). This will increase the help an

individual suffering from severe mental illness can receive, regardless of toxicology reports.

being released from the emergency room. Upon being released, Deeds went home and stabbed

his father, then himself. After the horrific events were revealed, it came to light that none of the

surrounding hospitals were contacted looking for a bed, which they indeed did have available

(Hartman, B., 2014). In this case, the health care system failed Deeds and resulted into two

heartbreaking deaths, however, this unfortunately happens all too often. Individuals are turned

away from emergency rooms or left to wait in ill-equipped emergency rooms until a psychiatric

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bed is open. Emergency rooms and standard hospitals are not the least bit equipped to deal with

someone suffering from a detrimental mental health crisis, resulting in their symptoms worsening

instead of healing the person. In a 2008 report from the Treatment Advocacy Center (n.d.), found

17 public psychiatric beds per 100,000 citizens, decreasing from 340 beds per 100,000 U.S

treatment in a familiar environment" (Administrator., n.d.).

treatment times expected for those that have been waiting and turned away multiple times. It will

inevitably cost taxpayers more money. This study found out that "in 2012, it was estimated that

healthcare costs in the USA accounted for 17% of the US gross domestic product" many of

which hold opinions that it is much too high to spend on healthcare (Russakoff, M., 2014). In

addition to increased costs, this also pulls resources – for example, law enforcement officers. If

an individual is experiencing a public mental health crisis, law enforcement will most likely be

called. This pulls resources away from law enforcement agencies to de-escalate the situation

while more serious crimes or concerns could be happening that need the extra law enforcement