Understaffed state psychiatric facilities leave mental health patients in limbo

Many patients struggling with mental crises have to wait several days in the emergency room for beds to become available in one of Georgia’s five state psychiatric hospitals as public institutions across the country feel the pinch of the coronavirus 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 pandemic, causing backlogs among poor or uninsured patients and people in prisons waiting to be placed in government facilities.

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Many civil servants, such as nurses, leave the 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 cater to patients, often poor or uninsured, forcing some people with severe mental illness to languish in hospitals or prisons until beds are opened in state systems, according to the local leaders from the National Alliance for Mental Illness.

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

Unprecedented mental crisis

At the national level, the lack of beds and mental health professionals collides with an increasing pandemic-related demand for psychiatric treatment.

“The emergency rooms have been inundated with patients in need of psychiatric care,” 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 admissions to state mental hospitals due to staff shortages as the demand for services increases. “I’ve never seen a system bottleneck this bad,” 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 said.

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 mental health facility to provide workforce support.

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 also filled.

Dr. Brian Hepburn, director of the National Association of State Mental Health Program Directors, said the behavioral health system, like the entire medical system, is “under great strain”. The shortage of staff in inpatient or inpatient behavioral medicine facilities is particularly acute, and the pressure is also being transferred to private providers.

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

Lots of people chase after the Covid money.

In Georgia, about 100 beds in the state’s five mental hospitals are empty – 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.

Melanie Dallas, CEO of Highland Rivers Health, which provides behavioral health services in Northern Georgia, said the challenge of handling higher demand with such a smaller number of staff is unprecedented in her 33 years in the field beyond hospitals. “Everyone is exhausted,” she said.

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

It’s “hard work and grueling,” said Hannah Longley, Maine Community program director for the National Alliance on Mental Illness. Government work does not offer a “significant package of salaries and benefits,” she said.

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 for people with developmental disabilities at a government facility in Augusta, Georgia. She said that temporary employment agencies offer “three times the salary” paid by government agencies, but that she stays there because she likes her job.

Kim Jones, executive director of the National Alliance on Mental Illness in Georgia, said she has received more calls about people with mental health problems who cannot receive long-term hospital benefits as the backlog builds.

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

The backlog in public services is playing out in prisons across Georgia, where 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 jail, 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. Robin Rau, the CEO of Miller County Hospital in rural southwest Georgia, said people with mental illness arriving to the emergency room are “actually at the end of the line.”

Rau said the bed jam was terrible. “Covid just made things worse,” she said.

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