Psychiatric bed shortages leave patients in limbo

Many patients struggling with mental health crises have to wait several days in an emergency room for a bed to become vacant in one of Georgia’s five state psychiatric hospitals as public institutions across the country feel the pinch of the pandemic.

“We are in crisis mode,” said Dr. John Sy, an ambulance in Savannah. “We held eight to ten patients two weeks ago. Some of them had been there for days. “

The shortage of beds in Georgia’s state mental health facilities reflects a national trend associated with staff shortages that limit services in the public mental health system. The bed capacity problem, which has existed for years, has worsened during the Covid-19 pandemic, causing backlogs among poor or uninsured patients and people in prisons waiting to be placed in government institutions.

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Many civil servants, such as nurses, leave these mental health departments for much higher wages – with temp agencies or other employers – and less stressful conditions. The departures have limited the capacity of state mental health facilities to accommodate patients, often poor or uninsured, forcing some people with severe mental illness to languish in hospital emergency rooms or prisons until beds are opened in the state systems said local leaders of the National Alliance for Mental Illness.

“Such patients are sometimes buckled or kept in isolation and often receive little or no psychiatric care,” said Roland Behm, a board member of the Georgia Chapter of the American Foundation for Suicide Prevention.

Unprecedented mental crisis

At the national level, the shortage of beds and mental health workers collides with an increasing pandemic-related demand for mental health care.

“The emergency rooms have been inundated with patients in need of psychiatric treatment,” said Dr. Robert Trestman, chairman of the Council on Healthcare Systems and Financing of the American Psychiatric Association. “The current crisis is unprecedented in the extent, severity and extent of its national impact.”

Virginia has severely restricted admission to state mental health clinics due to staff shortages and increased demand for services. “I’ve never seen an entire system bottleneck this dire,” said Kathy Harkey, executive director of the Virginia Chapter of the National Alliance on Mental Illness. The burden spills over onto the private system, she added.

An advisory committee in Texas reported in July that there was a near-record number of people on the waiting list for government hospital beds for forensic patients, those who are involved in the judicial system and suffer from mental illness.

Last month, National Guard soldiers returned to Oregon’s largest public psychiatric facility to support the workforce there.

In Maine, a committee of criminal justice and mental health officials has been working to establish state mental hospital beds and find places for people who need treatment for mental illness but are held in prisons.

The well-insured can usually choose private facilities or a general hospital mental health department, Trestman said. But in many cases these beds are now filled too.

Like the medical system as a whole, the behavioral health system is “under great strain”, said Dr. Brian Hepburn, director of the National Association of State Mental Health Program Directors. The staff shortage in inpatient or inpatient behavior therapy facilities is particularly acute, he said, and this pressure is also exerted on private providers.

States are now focusing on suicide prevention and crisis services to ease pressure on emergency rooms and inpatient services, Hepburn added.

In Georgia, about 100 beds in the state’s five mental hospitals are empty – or about 10 percent – because no one cares about the patients they would occupy. Space in short-term crisis units is also becoming scarce. According to the state Ministry of Behavioral Health and Developmental Disorders, the turnover rate of hospital employees was 38 percent in the past fiscal year.

Hospitals aside, Melanie Dallas, CEO of Highland Rivers Health, which provides behavioral health services in northern Georgia, said the challenge of dealing with such a smaller number of employees with higher demand was unprecedented in her 33 years in the field. “Everyone is exhausted.”

At the national level, many nurses and other mental health workers have left government agencies.

It’s “hard work and it’s grueling,” said Hannah Longley, community programs director for the Maine Chapter of the National Alliance on Mental Illness. State work does not offer a “substantial salary and benefit package”.

A nurse at a US state hospital typically makes $ 40 to $ 48 an hour, while the rate for a temporary nurse is between $ 120 and $ 200, Trestman said.

“Lots of people are chasing the Covid money,” said Netha Carter, a nurse who works at a government facility for the developmentally disabled in Augusta, Georgia. She said that temping agencies offer “three times the salary” of government agencies even though she stays there because she likes her job.

Kim Jones, executive director of NAMI in Georgia, said she has received more calls about people with mental health problems who cannot get long-term hospital care as bed backlogs increase.

Such waiting times for care can worsen the patient’s condition. A few years ago, Tommie Thompson’s son Cameron waited eleven months in prison to get a government hospital bed in Atlanta. “When he got to the hospital, he was totally psychotic,” said Thompson.

The public service backlog is happening in prisons across Georgia, and more people are being held behind bars because mental health facilities are overcrowded.

The Georgia Sheriffs’ Association said its members had reported their difficulties in referring people to government treatment. “A lot of these people don’t have to be in prison, but they are stuck there,” said Bill Hallsworth, the Association’s coordinator for the prison and judicial services. “There is no place to put them.”

Hospital emergency doctors are also feeling the shortage of government beds, said Anna Adams, senior vice president of the Georgia Hospital Association. People with mental illness who arrive to the emergency room “tend to be at the end of the line,” said Robin Rau, CEO of Miller County Hospital in rural southwest Georgia.

Rau said the bed jam was terrible. “Covid just made everything worse.”

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