|
Report reveals
psych bed shortage
(May
2008 Issue)
By Phyllis Hanlon
In March, the non-profit Treatment Advocacy Center (TAC) in Arlington,
Virginia, released a report citing a drastic shortage of psychiatric
beds nationwide with some New England states earning low marks.
One of the report co-authors, Jeffrey Geller, M.D., MPH, professor
of psychiatry and director of public sector psychiatry at the UMass
Medical School and TAC board member, says media accounts of violent
crimes committed by seriously mentally ill individuals and difficulty
accessing beds in the public sector prompted the report.
Fifteen unnamed experts on psychiatric care in the United States
evaluated the number of seriously mentally ill individuals who do,
or might, need hospitalization, length of stay, number of short
and long-stay beds and how those beds are financed. Based on these
factors, the experts estimated a need for approximately 50 beds
per 100,000 people. Geller points out that this number assumes the
availability of optimally operating community support services.
The report finds that as of 2004-2005, Vermont had 8.9 beds per
100,000, which translates to a critical shortage. Five other New
England states showed a severe shortage: Rhode Island, 12.5; Maine,
12.6; Massachusetts, 15.8, and New Hampshire, 17.2. With 25.4, Connecticut
showed a serious shortage of psychiatric beds.
The consequences of these shortfalls include homelessness, overflowing
hospital emergency rooms and increased violent crime, according
to the report. Additionally, jails and prisons become psychiatric
hospitals as a result of insufficient beds.
The report suggests more state government accountability, implementation
of Programs of Assertive Community Treatment (PACT) and assisted
outpatient treatment (AOT) to alleviate the situation. Other recommendations
include flexibility in federal and state regulations regarding alternatives
to inpatient psychiatric care and awareness programs to educate
the public about the repercussions of too few inpatient beds.
Michael Hartman, commissioner of mental health for the Department
of Mental Health in Vermont, reports with a population of approximately
500,000, Vermont would need 250 beds, according to the TAC report.
"Out of the 250 they say we should have, we might be 45 short,"
Hartman says. "But I'd like to point out that we have at least six
to 10 group homes operated by DMH with a varying capacity. They
total close to 85 beds in the end."
Hartman indicates that his state has been transitioning from inpatient
to residential care. "We are shifting the system out of primary
mode in terms of inpatient care and moving to a more geographically
dispersed [system]," he says. "There will be a number of new levels
of care within the mental health system. We'll be able to more competently
match the level of need with the level of services."
Hartman says, "My overall sense is that [the report] makes good
points about how, in general, we're not dealing with mentally ill
persons the way we deal with other problems in this country," says
Hartman, but adds that there is a "lot of mixing of apples and oranges
in the report."
Geller admits that "scores of variables" can impact the final results.
"You have to drill down the information when looking at each individual
state," he says.
|
