Shortage of psychiatric beds

A must read:

The Treatment Advocacy Center recently posted a report on their web site on the Shortage of Public Hospital Beds: http://www.treatmentadvocacycenter.org/Reportbedshortage.htm. Pennsylvania is listed under the category of "Severe bed shortage (12-19 beds per 100,000 population)," with just 18.9 beds per 100,000 population.

Fifteen experts on psychiatric care in the United States were asked "to assume the existence of good outpatient programs and the availability of outpatient commitment and told them that they would not be publicly identified."
As stated in the report, "The replies received were surprisingly consistent. Almost all 15 experts estimated a need for 50 (range 40 to 60) public psychiatric beds per 100,000 population for hospitalization for individuals with serious psychiatric disorders. Since it assumes the availability of good outpatient programs and outpatient commitment, this is a minimum number."
As the chart shows, Pennsylvania currently has 2,349 beds, and using the formula above of 50 per 100,000, we should have 6,182 beds, or an increase of 3,833.
I'm not certain why our state continues to down size and close our state hospitals. Maybe its time to find out before even more beds are lost.
One of the six solutions offered is "Implementing and using PACT [a.k.a. ACT] programs and assisted outpatient treatment (AOT) in every state; both programs have been proven to decrease the need for hospitalization." Thankfully, our state OMHSAS is increasing the number of ACTs in our state and will soon be publishing PA ACT Standards which will ensure fidelity to the model.
We now need to work even harder to see our AOT bill, SB 226 pass. With your help, we can.

(An article on Poynteronline was also posted on this week on this vitally important issue)

Closing of psychiatric hospitals

On her latest post, The Trouble with Spikol, Liz Spikol writes about the possible closing of a New Jersey hospital due to the terrible conditions that exist. No mention is made of how to improve those conditions, just that Ancora Hospital should be shut down.

However, I think the comments made by some of her readers are very insightful and explain that it isn't as simple as closing down a facility that doesn't provide the care that is desperately required for someone who has a diagnosis of a severe mental illness and needs very intensive support.

HS wrote, "Despite the clear lacking in care at hospitals like Ancora the reality is that the patients they treat can't live on there own and most do need an inpatient hospital level of care." Stan stated "Sure you can close down the hospitals, (they did that is California a long time ago without private or community resources’ to feel in the gaps, and you had lots of mentally ill people living on the streets without or with very limited mental health care options). So then where do you put these people?"

I think both of their comments show that this issue is more complex than just mandating the closure of hospitals. The consequences could be even worse for those in need of intensive support than what already exists.

Although Stan is not in favor of hospitals serving everyone with a mental illness, he acknowledges that some individuals do that that level of care, "I’m definitely not convinced that institutions are the best way to provide effective mental health services unless we are dealing with the most extreme and dangerous patient population."

I also agree with his analysis that "holistic community based programs would not only be more effective and humane, but would be much more cost effective also." Assertive community treatment (ACT) programs can fill that need, when they are run well and follow the model.
However, in states where inadequate treatment laws exist, those who are unable to seek treatment because of their lack of insight would receive no supports or services at all. Only assisted outpatient treatment laws could help those individuals.

I think we've reached a crisis point in how we approach these issues and intensive attention needs to be paid to providing the proper supports to those who are often the most vulnerable in our society. Until then, we will continue to see an increase of homelessness, incarcerations, and victimization.

We need to act now.