Thursday, June 21, 2007

Increasing population; decreasing hospital beds

Peg Falcone, a licensed clinical social worker who works at Southern Illinois Regional Social Services, brings up an excellent point in a recent op-ed – the care in psychiatric hospitals is not what it used to be. It is better.

Improved medications and methodologies of care make the experience of a patient in a modern-day facility far removed from what inspired Ken Kesey to write One Flew Over The Cuckoo's Nest. Indeed, much of the trepidation still invoked by the possibility of psychiatric hospitalization is an echo of conditions in some – but by no means all – facilities from decades past.

It is not only the hospital conditions themselves that have changed; so too have the characteristics of the patients and the purpose of their stay.

In 1955, there were 560,000 patients in state psychiatric hospital. In 2000, there were about 56,000. Even those startlingly disparate figures do not fully reflect the fading role of inpatient facilities. During that same period, the population of the United States increased from 193 million to over 280 million. Adjusted for population, fourteen out of fifteen people who would have been in a psychiatric hospital in 1955 were living in the community by the millennium – over three-quarters of a million people.

The chief role of facilities is no longer as long-term residences for and – as was necessary for some before the advent of effective medications – containment of those with severe mental illness. The main function of a modern psych hospital is stabilization and the facilitation of reentry into the community. Stays are no longer counted in months and years but in months, weeks and even days. That evolution continues. Stays in private psychiatric hospitals averaged 21 days in 1980; that had shrunk to 5-6 days by 2004.

This radically altered role for inpatient psychiatric hospitals also impacts on judicial determinations to place people in such facilities. The better the hospitals are and the shorter the anticipated stay is, the less the burden placed on someone being placed in one by a court. And the less that burden, the greater is the relative value of the treatment.