There is a shortage of psychiatric beds in Pa. The effects may be showing. | Opinion
How many excess deaths are occurring because the state won’t prioritize people in need of mental health treatment?
In 2020, five people in Pennsylvania died by suicide every single day. Countless more think about it or make an attempt. The rates of suicide among men and women have risen steadily over the last two decades. This is perhaps one of the most preventable tragedies that exist in contemporary society.
Gov. Tom Wolf’s proposed budget includes significant investments to improve access to treatment for people with mental illness, including $75 million to address workforce shortages. But it’s not nearly enough.
We need to create more psychiatric beds.
» READ MORE: Pandemic unveils growing suicide crisis for communities of color
Suicide is a symptom of serious mental illness such as schizophrenia and severe bipolar disorder, which affect roughly 330,000 people in Pennsylvania, half of whom are not treated. Suicide may be prevented if one can intervene between the suicidal impulse and action.
Psychiatric inpatient beds play a critical role in that intervention and can literally save a patient’s life, providing time for them to stabilize and to come up with a treatment plan.
But Pennsylvania has a critical shortage of psychiatric beds. To meet the demands of the population, the Treatment Advocacy Center — where I work — recommends 40-60 beds for every 100,000 people; Pennsylvania has fewer than 11.
Pennsylvania must do more.
Inpatient psychiatric treatment has a long history in Philadelphia, and today’s psychiatric hospitals barely resemble the asylums of the past. The concept of asylums to care for people with mental illness first began in Philadelphia around the time of our nation’s founding and expanded across the country for the next 200 years, resulting in their peak in the 1950s. In response to horrible conditions and the discovery of medications making it possible for individuals to live successfully in the community, after the 1950s, the number of psychiatric treatment beds fell even more quickly than they rose, in what is referred to as the deinstitutionalization movement.
But the pendulum swung too far. Although the ideas behind the deinstitutionalization movement were sound — most people with severe mental illness can live in the community with adequate support — the execution was lacking.
“How many excess deaths are occurring because the state won’t prioritize people in need of mental health treatment?”
As psychiatric beds decreased, suicide rates increased; today, the United States has fewer psychiatric beds per capita than most industrialized countries, yet the highest suicide rates. Could those two factors be related?
Psychiatric bed occupancy rates are a measure of psychiatric bed availability and are related to how beds are used for psychiatric treatment. When there is a shortage of psychiatric beds, providers have higher thresholds for admission of patients with serious mental illness, to make sure they save these scarce resources for the patients that need them the most. This has a significant impact on the type of care patients receive: The same patient presenting to an emergency department with significant suicide risk may be admitted to an inpatient bed if one is available, but discharged home if the inpatient beds are occupied.
As a result, some suicides occur that may be prevented. Indeed, new research shows that high psychiatric bed occupancy in Veterans Health Administration hospitals was linked to a 10% increase in the risk of suicide among veterans, an estimated excess of 65 deaths over a six-year period.
Right now, psychiatric hospitals in Pennsylvania are operating at extremely high occupancies, in part due to severe staffing shortages due to COVID-19. In one local hospital for people with addiction or behavioral health issues, staffing issues have resulted in one nurse covering a 44-patient unit. How many excess deaths are occurring because the state won’t prioritize people in need of mental health treatment?
It is our state government leaders’ moral imperative to protect our most vulnerable residents who are at risk of dying by suicide. Luckily, there are practical and evidence-based solutions to help them do so. Pennsylvania must prioritize addressing the lack of inpatient psychiatric capacity in its mental health system before more people lose their lives.
Elizabeth Sinclair Hancq is the director of research for the Treatment Advocacy Center. She lives in the Philadelphia area.
If you or someone you know is thinking of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text TALK to the Crisis Text Line at 741741.