New Report: Deficit of nearly 100,000 public psychiatric beds

The Treatment Advocacy Center released a report today that shows a nationwide shortage of nearly 100,000 public psychiatric hospital beds.

In 1955 there were 340 public psychiatric beds available per 100,000 U.S. citizens. By 2005, the number plummeted to a staggering 17 beds per 100,000 persons. Mississippi was found to have the most beds available in 2005 (49.7 per 100,000 people), while Nevada (5.1) and Arizona (5.9) had the least.

“The results of this report are dire and the failure to provide care for the most seriously mentally ill individuals is disgraceful,” said lead author, Dr. E. Fuller Torrey, president of the Treatment Advocacy Center. “Our communities are paying a high price for our failure to treat those with severe and persistent mental illness, and those not receiving treatment are suffering severely. In addition, untreated persons with severe mental illnesses have become major problems in our homeless shelters, jails, public parks, public libraries, and emergency rooms and are responsible for at least 5 percent of all homicides.” More...

Read the full report

15 or 16, but Not 17 – the Medicaid Numbers Game

Plug “16-bed” and “psychiatric” into Google and you will get over 26,000 results.

Hit on the first one and you’ll see that a full-time LPN is needed for the inpatient unit of a 16-bed psychiatric hospital in Muncie, Indiana. Delve further to find that a new 16-bed inpatient unit specifically dedicated to women’s mental health treatment opened in Westport, Connecticut last year. Also see that among the goals of an Arkansas provider is funding for four regional 16-bed adult inpatient facilities, one for each corner of the state. There will also be a link to a recent Associated Press story detailing that emergency rooms in New Orleans are flooded with psychiatric patients. One afternoon in one hospital, “18 of the emergency room's 23 beds held patients waiting for admission to a psychiatric ward.” A hospital spokesman commented that creating “a 16-bed psychiatric ward” would take months.

Doing the same search using “15-bed” yields a similar number (more than 20,000) and mix of items, but the results for “17-bed” are startling. There are only 681 results and most of them are links like those you sifted out in the other searches, ones where the two search terms appear to have only coincidentally been on the same page. You find out information like that there is a just-opened inpatient transitional medical care unit for patients in New Jersey with 17 beds. What 17-bed mental health care units there are mostly specialize in the care of children and adolescents or geriatric patients.

There are exceptions, such as a 17-bed medical/psychiatric unit attached to the University of Kentucky Hospital, but the conclusion is undeniable – there is a scarcity of 17-bed psychiatric facilities. The reason why, not surprisingly, comes from Capitol Hill.

The large majority of inpatient psychiatric care is paid for by either Medicaid and Medicare. The federal government reimburses states for a portion – typically one half or more – of the cost of the psychiatric care provided for people covered by these programs. When these governmental insurance programs where drafted and passed in 1965, care in “institutions for mental diseases" (IMD) was specifically excluded from Medicaid reimbursements to essentially force deinstitutionalization.

There are exceptions to this repayment prohibition; reimbursement is available for inpatient care rendered for minors and those over 65, in facilities where psychiatric treatment is given to less than half the patients, and in psychiatric hospitals of 16 patients or less. After forty years of operation, these artificial policy incentives have haphazardly sculpted the framework of inpatient mental health care – hundreds of hospitals have closed, juvenile care is largely unaffected, psychiatric patients have been increasingly mixed (albeit in a proportion less than 50%) into adult-care homes, and 17-bed psychiatric facilities are distinctly not en vogue.

Feds address Medicaid discrimination?

Congress is finally taking a look at the discriminatory Medicaid IMD exclusion.

When initially enacting Medicaid, the federal government specifically excluded payments for patients in state psychiatric hospitals and other "institutions for mental diseases," or IMDs, to accomplish two goals: fostering deinstitutionalization; and shifting the costs back to the states, which were viewed by the federal government as traditionally responsible for such care.

States proceeded to transfer massive numbers of patients from state hospitals to nursing homes and the community where Medicaid reimbursement was available. This resulted in a massive transinstitutionalization of people who needed inpatient care to facilities ill-equipped to fully help them.

TAC has long advocated for repeal of this discriminatory provision. We urge you to contact your representatives and call for passage of HR 1155.

From a NAMI email alert:

Congresswoman Eddie Bernice Johnson (D - Texas) has introduced a bill, HR 1155, to repeal the current prohibition on the use of Federal Medicaid dollars to pay for services for individuals between the ages of 22 and 64 in private and public inpatient psychiatric treatment facilities. If enacted, HR 1155 would be extremely helpful both in addressing the ongoing crisis in inpatient services for people with severe mental illness and potentially expanding the availability of community-based services for these individuals. HR 1155 has been referred to the House Energy and Commerce Committee for consideration. Your Representative sits on this Committee. We urge you to write to your Representative and urge his/her support by co-sponsoring HR 1155.

State of the Union: Mental Illness

From National Journal - mental illness is one of the issues you will NOT hear addressed in tomorrow's State of the Union ...

After 40 years of blue-ribbon panels, myriad reports, and poorly aligned public policies, severe mental illness remains an intractable and deepening problem in America. For proof, look no further than the homeless lady muttering on the corner outside your office building.

"Mental illness is the No. 1 public health crisis in the U.S. today," declared Ron Honberg, legal director for the National Alliance for the Mentally Ill, an advocacy group based in Arlington, Va. ...

In 2001, the most recent year for which official figures are available, the U.S. spent $85 billion on mental health treatment. Experts estimate that figure is closer to $130 billion today, with federal prescription coverage included. The costliest subset by far is the severely and persistently mentally ill -- about 12 million adults with schizophrenia, bipolar disorder, and major depression -- who account for 58 percent of the spending, according to researcher and activist E. Fuller Torrey ....

It doesn't help that the federal government continues a long-standing ban on the use of Medicaid money to fund state mental hospitals, said Mary Zdanowicz, executive director of the Treatment Advocacy Center. The policy led to a wholesale emptying of state psychiatric hospitals in the mid-1960s and another wave of discharges in the early 1990s. "In Virginia, we've closed 50 percent of state hospital beds in the last 20 years," Zdanowicz said. "That's a critical -- and often overlooked -- loss for people who need intensive treatment for a severe mental illness."