BEHAVIORAL HEALTH
Facing a Psychiatric Bed Crisis When demand exceeds supply TODD ARCHBOLD, LSW, MBA
A
s the world is resetting in the hopeful light of recovery from the pandemic, the fragile state of the mental health of our populations is increasingly apparent. We’ve endured the devastation suffered from the loss of life from COVID-19, economic tail spinning, political divide, and the fatigue of quarantine. While the situation is improving by the day, its impact on mental health will be lasting. There is a mental health crisis in our communities, and among health care workers. A new paradigm with more flexible care and equalizing disparities must arise and it will take a united and concerted effort to fulfill.
The state of psychiatric healthcare in Minnesota There are over 1 million people in Minnesota experiencing symptoms of a mental illness today, which translates to almost one out of every 5 of us. The most common conditions are anxiety and depression, both of which have been greatly exacerbated by the impact of the pandemic. It is estimated that less than half of these individuals will ever seek help for their symptoms. Nearly 285,000 Minnesotan’s are currently struggling with a serious mental illness, resulting in substantial functional impairment and interference with
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major life activities (such as school or work). Our current “mental health system” is a collage of state operated, non-profit, and private providers offering often high-quality, but fragmented levels of care. Minnesota is home to some nationally recognized providers of health care ranging from Mayo Clinic and Allina Health to specialized behavioral health providers like Hazelden Betty Ford, PrairieCare, and The Emily Program. Collective efforts to improve population mental health in the past few decades have been largely focused on effective community-based services such as targeted case management, day treatment, school-linked services and mobile response. Inpatient psychiatric bed capacity across the nation has shrunk by over 90% since the 1950s through the movement of “deinstitutionalization”, moving many individuals with severe mental illnesses to emergency rooms, jails or the streets. There are nearly three times more individuals with a serious mental illness in jail or prison, than in treatment facilities. ERs have become the most common entry point for a psychiatric crisis, and on average it takes 3.5 days for a hospital bed to become available, and often much longer for children and adolescents. There are currently 202 psychiatric hospital beds for youth and 590 adult beds in Minnesota, not including state run facilities. These meager capacities are reduced even further by a shortage of staff. Minnesota ranks 50 out of all states on having the fewest number of psychiatric beds per capita (3.5 beds per 100,000). The recommendation by health policy experts is 40-60 mental health beds for every 100,000. Most psychiatric units are at max capacity, most of the time – especially child and adolescent units. Minnesota has a moratorium on hospital beds, which requires an arduous and costly review process that ultimately requires legislative approval to add new licensed beds. This has prevented some systems from responding to this crisis. The state recently adopted the national model for Psychiatric Residential Treatment Facilities (PRTF), yet most commercial insurance companies have excluded PRTF care in contracts, creating access barriers and endless stress for patients and families. The availability of psychiatric hospital beds in Minnesota is so limited, that the Department of Human Services and Minnesota Hospital Association created an online tool to help providers find available psychiatric beds across the state in real-time. Most often psychiatric beds are classified simply by age range; however, the term “psychiatric bed” is a misnomer as the care required for patients in crisis varies greatly. A psychiatric episode of care may vary from short-term stabilization, to several weeks of evaluation and complex medical support. Regardless, many days the bed finder tool will show that there are zero beds available. No other area of acute health care requires a bed finder – what does this tell us about the way we are responding to psychiatric needs in the state?
A look at what is broken For directions or additional information about the Minneapolis Clinic of Neurology
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MARCH 2021 MINNESOTA PHYSICIAN
The main barriers we face in maintaining psychiatric inpatient units are not hard to understand. Why do we see ongoing expansion of birthing units, cardiology, and orthopedics, but not psychiatry? The data clearly suggests the need for psychiatric services, and the mortality rates of severe
