May 1st, 2014

Inpatient beds: Demand but short supply

The process of deinstitutionalization, along with the subsequent closure of facilities and reduction in beds, began some 35 years ago. While community services were hailed as the best treatment option, they often did not prove to be an effective and appropriate approach for some individuals. The practice of closing beds continues today with some of the same repercussions experienced decades ago.

Barbara Stone Amidon, Ph.D., has been on the Psychiatric Assessment Team at Cape Cod Hospital for the last 10 years. During that time she has witnessed children who present to the emergency room with a psychiatric diagnosis and then wait three or four days or more for a bed.

Acknowledging the trend toward wraparound and community services, she says that this approach does not work for some children. In her role conducting evaluations for inpatient placement and working with the juvenile court system, she has an “up-close and personal viewpoint” and finds that the combination of an increase in mental illness and a decrease in beds is fueling a crisis, she says. “I am seeing more mental illness than 10 years ago. Everyone in the industry will say it’s better to give outpatient care, but if there is none, the patients end up in the hospital.”

The southeast part of Massachusetts faces a particular challenge. “It can take two months to get an appointment with a psychiatrist because there are too few practitioners. Elderly beds are few and far between and sometimes we have sent geriatric patients as far as Clinton,” Amidon says.

Cape Cod Hospital closed its adolescent unit in the ‘90s, according to Amidon. “They did have a stabilization unit for a year and closed that in early 2000. There are no child and adolescent beds on the Cape,” she says. “Dual diagnosis beds are more scarce than pediatric and adolescent beds.”

In the Boston area, the situation is not much better. Kathleen Trainor, Psy.D, founder of the TRAINOR Center in Natick and senior psychologist at the Child Psychiatry Clinic at Massachusetts General Hospital, points out that in the best case scenario, a bed is found within a day. However, frequently a child will be held in the emergency room for as many as four days. “This is a nightmare for the child and the parents,” she says.

Furthermore, if a clinician attempts to admit a patient directly to the hospital, the wait can be even longer. A 15-year old patient of Trainor’s with anxiety so disabling he could not go to the emergency room was admitted only after daily calls to the hospital for three months. “Hospitals have an agreement with the ER. They prioritize patients who go to the ER and give them beds first. But it’s an ordeal for some patients to go through the ER,” she explains.

In another situation, one of Trainor’s patients sat in the ER for four days until her parents finally took her home. “Parents go through this situation, hopefully, only once and then want to forget about it. They are in no position to advocate for themselves. There’s a stigma so they don’t want to be vocal,” Trainor says.

Amidon believes that society needs to “go back to basics.” She says, “We need to look at prevention from cradle to grave. When families fall apart, the kids fall apart. We need a really good society around all people,” she says. “Part of it is that we live in a tough society. We want instant gratification and don’t always feel good. Family life is tough with both parents working. In the past, more family was involved. The quantity of connection may be there, but the quality is not.”

By Phyllis Hanlon

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