Under-staffed public psychiatric facilities leave mental health patients in limbo


Many patients with mental health crises have to wait several days in the emergency room until a bed becomes available at one of Georgia’s five state mental hospitals, as public facilities nationwide feel the pinch of the pandemic.

“We are in crisis mode,” said Dr John Sy, an emergency doctor in Savannah. “Two weeks ago we were probably holding eight to ten patients. Some of them had been there for days.

The shortage of beds in psychiatric facilities in the state of Georgia reflects a national trend related to staff shortages that hamper the services of the public mental health system. The bed capacity problem, which has existed for years, worsened during the covid-19 pandemic, creating backlogs of poor and uninsured patients as well as incarcerated people awaiting placement in public facilities.

Many state employees, like nurses, leave these psychiatric units for much higher pay – with temp agencies or other employers – and less stressful conditions. Departures have limited the capacity of state-run psychiatric units for patients, who are often poor or uninsured, forcing some people with severe mental illnesses to languish in hospital emergency rooms or prisons until what beds open up in state systems, according to local leaders. of the National Alliance Against Mental Illness.

“These patients are sometimes tied up or kept in isolation and often receive little or no mental health services,” said Roland Behm, board member of the Georgian chapter of the American Foundation for Suicide Prevention.

Nationally, the shortage of mental health beds and workers has been met with a growing demand for mental health treatment due to a pandemic.

“The emergency room has been inundated with patients requiring psychiatric care,” said Dr. Robert Trestman, chair of the American Psychiatric Association’s Council on Health Systems and Funding. “The current crisis is unprecedented in the scope, severity and magnitude of its national impact.”

Virginia has dramatically reduced admissions to state mental hospitals due to a staffing shortage amid increased demand for services. “I have never seen such a severe system-wide bottleneck,” said Kathy Harkey, executive director of the Virginia section of the National Alliance on Mental Illness. The tension is spreading in the private system, she added.

A Texas advisory committee reported in July that a near-record number of people were on the waiting list of state hospital beds for forensic patients, that is, those involved in the justice system who suffer from mental illness.

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

In Maine, a committee of criminal justice and mental health officials worked on add state psychiatric beds and find placements for people who need treatment for mental illness but are detained in prison.

Well-insured people can normally choose private facilities or general hospital psychiatric wards, Trestman said. But in many cases these beds are now also filled.

Like the medical system as a whole, the behavioral health system is “under strain,” said Dr Brian Hepburn, chief of staff. National Association of State Mental Health Program Directors. The labor shortage is particularly acute in inpatient or residential behavioral health facilities, he said, and this pressure extends to private providers.

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

In Georgia, about 100 beds in the state’s five mental hospitals – or about 10% – are empty because there is no one to care for the patients who would occupy them. The space in short-lived crisis cells is also reduced. Hospital staff turnover was 38% in the last fiscal year, according to the state Department of Behavioral Health and Developmental Disabilities.

Beyond Hospitals, Melanie Dallas, CEO of Highland river health, which provides behavioral health services in northern Georgia, said the challenge of dealing with higher demand amid such a small number of staff is unprecedented in his 33 years in the field . “Everyone is exhausted.

Nationally, dozens of nurses and other mental health workers have left public jobs.

It’s “hard and exhausting work,” said Hannah Longley, director of the community program at Maine Chapter of the National Alliance on Mental Illness. State work does not provide “a significant salary and benefits”.

A nurse at a public hospital in the United States typically earns between $ 40 and $ 48 an hour, while a temp agency nurse’s rate ranges from $ 120 to $ 200, Trestman said.

“A lot of people are chasing covid money,” said Netha Carter, a nurse practitioner who works at a public facility in Augusta, Ga., For people with developmental disabilities. She said temp agencies offer “triple the pay” offered by public establishments, even if she stays put because she enjoys the kind of work she does.

Kim Jones, executive director of NAMI in Georgia, said she has received more and more calls about people with mental health needs who could not obtain long-term hospital services as the number of beds increases.

Such expectations for care can make patients’ condition worse. Several years ago Tommie Thompson’s son Cameron waited 11 months to get a public hospital bed in Atlanta while in prison. “By the time he got to the hospital he was totally psychotic,” Thompson said.

The backlog of public services is evident in prisons across Georgia, with more people being held behind bars because mental health facilities are inundated.

The Georgia Sheriffs Association said its members have shared their difficulties in placing people in state-run treatment. “A lot of these people don’t need to be in jail, but they are stuck there,” said Bill Hallsworth, the association’s prison and court coordinator. “There is no place to put them.”

Hospital emergency rooms are also feeling the lack of state beds, said Anna Adams, senior vice president of the Georgia Hospital Association. People with mental illness who arrive in emergency rooms “tend to be on the phone,” said Robin Rau, CEO of Miller County Hospital in rural southwest Georgia.

Rau said the bed backlog is horrible. “Covid has just exacerbated everything. “

Need help?

If you or someone you know is in crisis, call National lifeline for suicide prevention at 1-800-273-8255 or send HOME to the crisis text line at 741741.

This article was reprinted from khn.org courtesy of the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorial independent news service, is a program of the Kaiser Family Foundation, a non-partisan health policy research organization not affiliated with Kaiser Permanente.


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