The Covid-19 pandemic has dramatically cut the availability of inpatient psychiatric beds, with facilities across the country forced to reduce their capacity to meet social distancing requirements, stem outbreaks of the virus, or repurpose psychiatric beds to care for the surge of Covid-19 patients.
The crisis — combined with years of mental health care budget cuts, rising demand for mental health care, and an existing shortage of both psychiatric beds and providers — appears to have put health care systems on a wartime footing.
“Every day is an emergency,” said Vincent Carrodeguas, CEO of Miami based Banyan Health Systems. “I hate to say it but our job right now is to normalize a crisis that has been going on for nine months. Calls to our centers are up 40 to 50% and our vulnerable behavioral health population has skyrocketed.”
The pandemic and the parallel economic crisis have fueled new concern about access to mental health care. An estimated 40% of American adults have a condition involving mental illness or substance misuse. In June, federal health officials reported nearly 11% percent of adults surveyed seriously considered suicide during the past 30 days.
“Patients are a lot sicker and in greater need of intervention” since the pandemic began, said Gail Ryder, vice president at Tampa, Florida-based BayCare Behavioral Health. But finding patients a bed is proving increasingly challenging.
“It was hard to find a bed before Covid-19,” said Steven Winn, CEO of Springfield, Mass.-based Behavioral Health Network. Winn estimated the state has lost 300 pediatric and adult psychiatric beds in the past year. Western Massachusetts, a region home to more than 800,000, lost all of its remaining pediatric psychiatric beds by June. Nationwide, the availability of inpatient psychiatric and 24-hour residential treatment beds has declined significantly over the past five decades, according to John Snook, executive director of the nonprofit Treatment Advocacy Center.
The flood of Covid-19 cases and the threat of outbreaks have only made that problem worse. In Virginia, Gov. Ralph Northam signed a temporary executive order in August to stop admissions to psychiatric hospitals in an attempt to mitigate spread of the virus. In Minnesota, meanwhile, a mental health crisis residential stabilization facility was forced to temporarily shut down in September after an employee tested positive.
Government waivers have also allowed hospitals around the country to repurpose psychiatric beds to care for pandemic victims. A new long-term psychiatric facility at Staten Island University Hospital did not open as planned last spring. It now serves as a Covid-19 field hospital.
In Kingston and Brooklyn, New York, some psychiatric units were closed in the spring to increase the capacity to care for Covid-19 patients. Mental health patients there were transferred to other hospitals.
At the same time, hospitals have continued closing inpatient mental health units due to financial losses. Mercy Iowa City, a major Iowa health system, announced its psychiatric unit will close at the end of the year. And in Rockford, Ill., another health system, Mercyhealth, got the greenlight in September to shut down its mental health unit.
Some recent moves to take away psychiatric beds have been met with fierce pushback. The temporary closure of a psychiatric unit at Long Island’s Syosset Hospital in July — a decision made to open up space for medical and surgical patients, which generally have higher reimbursement rates, at a time when hospitals are increasingly financially strained — sparked a state nurses association protest. No plans have been announced to reopen the facility.
Those shuttered behavioral health units and repurposed beds have also complicated the process of placing a patient who needs intensive psychiatric care, which already posed significant challenges. Hospital leaders have historically blamed the shortage of psychiatric beds, in part, on federal restrictions on Medicaid reimbursement for inpatient mental health care and on staffing shortages.
“Before the pandemic, it took an average of 19 phone calls to place a psychiatric patient at a hospital somewhere in the state,” said Robert Sheehan, CEO of the Community Mental Health Association in Michigan. Now, to space patients physically apart as a infection prevention measure, some of the state’s four-bed units have become two-bed units, and some of the two-bed units are one-bed units, he said.
“Today there are a third less beds available for psychiatric patients and if the patient is acting hostile or abusive it’s even more difficult to find a hospital that will take them,” he said.
Fewer available behavioral health beds during the pandemic frustrates emergency room staff, who are often asked to care for patients for a prolonged period of time until they can be placed in a more appropriate unit.
“Right now ,we have four psychiatric patients boarding at our ED for more than three days,” said Tony Mancuso, an emergency department nurse in Western Massachusetts. And when a bed does become available, it is sometimes a significant distance from a patient’s home — which can prove particularly difficult for pediatric patients.
“Shipping young people hours away from their family to a hospital bed in another part of the state right now can be difficult,” said Winn, of the Massachusetts health network.
The pandemic has also led some state governments to consider further cuts to mental health care budgets. In September, New Jersey Gov. Phil Murphy proposed slashing funding for suicide prevention and counseling services. After widespread outcry, the state legislature restored the $15 million program matched by federal funding.
In a world deluged with daily updates on soaring Covid-19 cases and deaths, it’s difficult to recognize the combined impact of all these political and business decisions working against effective mental health care. Medical experts do not see the arrival of Covid-19 vaccines as a panacea.
“If people don’t have access to treatment when they need it, there can be tragic results at the individual and societal level,” said Elizabeth Hancq, research director of Treatment Advocacy Center.
“Escalating mental health problems submerged by the pandemic are going to have major long term effects,” Hancq said. “Right now many state legislators aren’t looking at anything that’s not related to this virus. There needs to be better funding as part of the response to Covid.”