The daily inpatient census at Providence’s Butler Hospital increased 14 percent in August 2014 over August 2013, creating what Rhode Island’s only private psychiatric hospital is calling “unprecedented” demand for mental health care.
And the rising demand continued as the average number of inpatients went from 175 in August to more than 180 in September. The August 2013 average inpatient census was about 153.
“The fall tends to be a somewhat slower time for us and as you can see, that is not happening so we are in historically new territory at this point,” says Butler Hospital Acting President and COO Lawrence H. Price, M.D.
Even with a 26-bed addition completed last fall, the Care New England Health System hospital opened up a 10-bed Adult Inpatient Overflow unit on weekends only over the summer. In September, it was used on four weekdays and three weekend days. The unit is in Butler’s Delmonico building in space formerly occupied by the Child and Adolescent Intensive Treatment Unit.
“It works pretty well as an overflow unit, because it’s small and we can use it as a place to keep people very briefly until we have a bed for them on one of the regular units, but it isn’t staffed in any kind of permanent way,” Price says.
One factor behind the demand, Price says, is that more people have insurance through the Affordable Care Act. New enrollments through HealthSource R.I., the state’s health care exchange, during the first open-enrollment period between Oct. 1, 2013, and March 31, 2014, totaled more than 92,000, including 64,590 accepted into Medicaid. It is unknown how many of those were among the 124,000 Rhode Islanders estimated without health insurance in a 2011 report by The Robert Wood Johnson Foundation.
“We do think that people are seeking treatment who previously simply weren’t seeking treatment,” Price says. “What’s striking about that is that these individuals who are seeking treatment are very ill so they’re meeting hospital level criteria. It’s not like the worried well are all of a sudden looking for help with career planning or minor adjustment issues. These are pretty seriously ill people who now appear to be seeking treatment.”
The average length of stay remains unchanged at around seven to eight days, with duration longer for geriatric patients, Price adds.
Other factors in the increased demand for beds are cuts in state funding for outpatient mental health services and Butler’s improved coordination with general hospitals to more quickly move psychiatric patients who arrive in emergency departments at other hospitals in the state to its facility, Price says.
Butler has not hired new staff to address the higher census, instead using its float staff and those looking for additional shifts. The hospital has continued to hire nurses and mental health workers for vacant float positions.
“We’re working very hard to keep up from a staffing perspective. We’re not staffed at levels that assume we’re going to be treating an average daily census of 180,” Price says. “In order to do that, our staff is making sacrifices and really pitching in so that we can accomplish that. It requires a real serious commitment.”
Rhode Island Hospital, part of the Lifespan network, had 637 mental health admissions between Jan. 1 and Sept. 22, down 0.6 percent from 641 in the same period in 2013. But Lifespan’s Newport Hospital saw a 4.3 percent increase from 302 to 315 comparing the same time periods.
“We are seeing increased volume in our outpatient care units,” says Lifespan Senior Vice President for Psychiatry & Behavioral Health Richard J. Goldberg, M.D. A new urgent care center and outpatient psychiatry program was scheduled to open Nov. 1 in Lifespan’s East Greenwich ambulatory-care center.
Care New England is partnering with the Providence Center to develop a system of care for outpatient and inpatient psychiatric disorders that would involve psychologists more directly in patient care, Price says. The assessment of behavioral health needs may create new opportunities to deploy psychologists to strengthen outpatient services in ways that can ultimately prevent individuals from needing hospitalization.
By Janine Weisman