RESEARCH WEEKLY: Psychiatric hospital beds: a ‘national disconnect’

(Dec. 23, 2015) The Treatment Advocacy Center is a leader in tracking and reporting the declining population of state psychiatric hospital beds, a vanishing breed whose numbers have shrunk by at least 95% in the last half-century. Now a team of North Carolina researchers has created a simulation model to analyze how many non-forensic beds it would take to reduce the amount of time people in psychiatric crisis currently spend waiting for a hospital bed.

The results dramatically illuminate what the authors call a “national disconnect between increasing demand for psychiatric inpatient care and decreasing supply” and what practically might be described as the size of the cracks in the inpatient mental health system.

To develop their model, Elizabeth M. La et al. studied a 25-county region of North Carolina where 3.4 million people are served by a 398-bed state psychiatric hospital. This translates into 11.7 state hospital beds per 100,000 residents, significantly fewer than the 50 beds per 100,000 people considered the minimum number for adequate public psychiatric services.

The Continuing Role of State Hospitals
In addition to the state hospital beds, the study reports that community-based crisis services in the region were providing 494 adult psychiatric beds in 14 general or private psychiatric hospitals and 66 non-hospital crisis beds in five facilities during the study period (July 1, 2010 to July 31, 2012). Though the resources increased the total number of available beds, they did not eliminate the role of the state psychiatric hospital, according to the study.

“When outpatient services are unable to help people prevent or manage crises, swift access to inpatient care in community general hospitals can be essential to ensure safety while medications are recalibrated and formal and informal supports are organized . . . ,” La et al. write in, “Increasing access to state psychiatric hospital beds: Exploring supply-side solutions.” “In contrast to community general hospitals, state psychiatric hospitals are designed and staffed to care for people with severe mental illness, including those who may become violent. Observers now believe that state hospitals will continue to serve patients whom general hospitals and private psychiatric hospitals cannot accommodate. In this respect, state psychiatric hospitals are the ultimate safety net for people with mental illness.”

What the Model Found
During the last six months of 2012, the authors found that an average of 520 adults in psychiatric crisis waited an average of approximately three days for admission to a hospital. (Not all patients on waitlists were ultimately admitted.)

Running variables through the model found that dramatic increases in state hospital beds would be needed to significantly decrease wait times for psychiatric beds and improve access to inpatient treatment. Projections included:

• Adding 24 beds increased the number of admissions by 9% (115.2 patients) and decreased average wait time by 6% (slightly less than four hours).
• Reducing average wait times to less than two days required increasing beds in the study hospital by 84%.
• Reducing average wait times to less than one day required increasing beds in the study hospital by 165%.

The model assumed unchanged demand for hospital treatment and supply of alternative psychiatric beds and intensive outpatient services in the community; a demand-side analysis would be needed to project how these service changes would affect the need for state hospital beds.

“However, many community facilities are not currently staffed to care for the most acutely ill psychiatric patients and those who become violent” the authors noted. “Thus, although buying community hospital beds may initially be less costly than adding state hospital beds, making community beds the sole solution would change community hospital staffing requirements, possibly increasing total costs for North Carolina.”

In economics, equilibrium is what occurs when supply and demand for products or services are equal. Consumers are getting the goods or services they want; sellers are selling the goods or services they produce. Demand is met, supply is consumed.

Equilibrium in psychiatric hospital beds was lost long ago. Elizabeth M. La et al. have developed a tool for mapping the disequilibrium. As grim as the map is, the authors have also demonstrated it is possible to analyze demand and project the supplies needed to meet it.

References:
Torrey et al. (2012). No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals. Treatment Advocacy Center.
La, E. M., et al. (1 December 2015). Increasing access to state psychiatric hospital beds: Exploring supply-side solutions. Psychiatric Services. Retrieved from http://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201400570