The Philly region has few beds for behavioral health patients — and intense demand
A system already ripping at the seams is being pushed to a breaking point, experts say.
Main Line Health opened a new behavioral health unit at Bryn Mawr Hospital on Tuesday that’s been in the works for years.
The $35 million unit boasts private rooms with lush murals; noise-canceling floors and ambient music to help patients with sensory issues; an exercise room and spacious areas for yoga classes and meditation; and special beds to care for patients with serious medical issues. Fund-raising began in 2018.
The unit will hold double the behavioral health beds at the hospital, and officials there hope it can ease some of the pressure on a long overburdened mental health system. But they’re under no illusions that it will solve the problem; it adds just 20 more beds to the hospital’s previous behavioral health capacity.
“Our new unit will be full on the first day,” Main Line CEO Jack Lynch said. “But we’re proud to make the investment to increase capacity here.”
Demand for behavioral health inpatient beds all over the state is outstripping supply even more than it had been before March 2020. The shortage is hard to quantify exactly, because not all inpatient beds are suitable for all patients, said Jennifer Jordan, the vice president of regulatory advocacy for the Hospital and Health System Association of Pennsylvania.
For example, a patient with high-level medical concerns can’t be sent to a conventional psychiatric facility that can’t treat those needs; and a young, physically healthy patient would be a poor fit in a psychiatric nursing home that caters to seniors with multiple problems.
Still, national surveys and studies suggest that an already overtaxed system was stretched to the breaking point during the pandemic. An October 2021 poll of the National Council for Mental Wellbeing, a group representing thousands of behavioral health and substance use treatment facilities around the country, found that 78% of about 260 respondents had seen increased demand for services over the prior three months. Three in five said their patient waiting list had grown in the previous three months.
‘We just don’t have the infrastructure’
The demand — and the pressure on providers — is due to a number of factors, experts say.
The emotional and financial strains of pandemic life have more people seeking mental health care. Medicaid reimbursements for behavioral health care historically have been relatively low — meaning that health-care providers may not have incentive to add new beds. And even when a health-care facility does decide to add behavioral health beds, the process can take years, between raising funds, hiring staff, and completing regulatory requirements.
“We just don’t have the infrastructure to meet all the needs of the people that are now being burdened with mental health disorders,” said David Greenspan, a psychiatrist who serves as the chair of psychiatry at Einstein Health Network.
Hospitals such as Greenspan’s, whose behavioral health unit can take 47 patients at a time, have found their emergency departments and crisis centers swamped with patients who can’t immediately access inpatient behavioral health treatment because there are simply no beds available for them.
And the problem, hospital officials say, is twofold. When some patients on a psychiatric ward get treatment and are ready to be released to a less-intensive inpatient setting or even an outpatient clinic, they can get stuck on the ward, waiting days or even months for a more appropriate placement.
Many treatment facilities won’t accept patients with complicated medical histories, experts said. “Patients with medical problems in the emergency department — no psych unit will take them,” said Marc Burock, a physician and the system medical director of behavioral health at Main Line Health. “Even patients with an eating disorder, even if it’s not active or severe — the majority of psych units will turn them down. They have a lot of leverage because there’s not enough psychiatric care in the system.”
Other patients will wait days for a placement because they’re COVID-positive, or because their mental illness has caused issues at a facility in the past.
“We have had people in our facility who we have declared stable for discharge for months, with no place to go. Certain patients, because of challenges they’ve had in other facilities, just aren’t welcome there. [These facilities] have no obligation to accept referrals,” Greenspan said.
He added that he has “a lot of empathy” for nursing homes, substance use rehabs, and other residential care providers taking psychiatric patients. Many, he said, simply aren’t equipped to care for higher-level medical needs. But, he said, that means patients in desperate need have to wait longer for beds.
Hopes for better times
During the pandemic, Einstein increased capacity at its crisis center, where patients in a mental health crisis go to get immediate treatment placements. But it still could hold only 15 patients at a time. At times, he said, those patients were waiting up to 24 hours to be sent to treatment; patients are supposed to spend, on average, just six hours there.
Like many other hospitals in the city, the crisis center was often on “divert” status during the pandemic, meaning it instructed police and paramedics to take patients elsewhere because there wasn’t room for them. Patients were still able to get into the hospital’s emergency room or onto a regular medical floor, Greenspan said, but they were still forced to wait for inpatient placement in a busy, stressful environment that’s not designed to treat them.
With COVID cases decreasing, Greenspan said, the pressure on the crisis center has eased. “I hope this is more than transient,” he said.
Burock and physicians at Main Line began active psychiatric treatment in the emergency department for patients waiting for a bed. They started giving medications and beginning telehealth therapy to make the wait more productive.
Jefferson Health-Abington’s 16-bed psychiatric unit can also treat behavioral health patients with other medical issues. But the unit is still typically full. Even just before the pandemic, the hospital began modifying some of its ER rooms to accommodate people with psychiatric issues waiting for a spot on the inpatient unit.
“They’re regular rooms, but they have, essentially, a garage door that we’ll pull down to hide all the equipment with cords, projectiles, or anything that’s a ligature risk,” said Gerard Cleary, Abington’s chief medical officer. “We’ve used it more since the pandemic — and we don’t have endless capacity of those types of rooms. The demand continues to rise.”
Jordan, who works with hospitals around the state, said HAP has made advocating for better access to behavioral health treatment a priority. The organization is particularly interested in finding funding for community resources that can help patients avoid a hospital altogether.
“Having adequate supports of housing, crisis services, job placement services, can take the pressure off the inpatient beds,” she said. “No fix is ever immediate in a behavioral health context — it requires money, infrastructure, and a workforce that needs to be identified and trained. But ... if we don’t fix it right now, we never will.”