As a continuation of our Mental Health Awareness Month series, this week's blog considers research on psychiatric bed shortages that was presented at the 2018 American Psychiatric Association (APA) annual meeting last week in New York City.
Presidential symposium on beds
For the first time in the 20-year history of the Treatment Advocacy Center, a presidential symposium on the need for increasing psychiatric beds was held at the 2018 APA annual meeting. This year, Treatment Advocacy Center Psychiatric Advisory Board Member, Steve Sharfstein, MD, lead a three-hour discussion titled "Tipping point: The critical decline in psychiatric hospital beds" was conducted by an international expert panel of bed researchers, a 'beds-club' that the Office of Research and Public Affairs (ORPA) brought together in 2015.
Richard O'Reilly, MD, presented data on psychiatric hospital bed availability in Canada, comparing treatment access issues to the US and other Anglosphere countries. Although Canada has 34 psychiatric beds per 100,000 population (compared to 21 beds per 100,000 in the United States), Canada has similar consequences from its bed shortages, including emergency department boarding of psychiatric patients and police officers increasingly becoming frontline mental health workers.
In addition, Dr. O'Reilly presented on the need and feasibility of producing psychiatric bed target numbers, estimating the number of beds needed to serve people with serious mental illness in a given area. He proposed utilizing hospital key performance measures and public health data to determine the tipping point of adverse outcomes when bed numbers go below a certain threshold.
Tarun Bastiampillai, MD, presented on the experiences of Australia in addressing the crisis of psychiatric bed shortages. In 2014, the Organization for Economic Co-Operation and Development (OECD) recommended, "given Australia's low bed numbers, attention should be paid to ensuring that care coverage does not suffer." At 40 beds per 100,000 population, Australia has almost double the number of beds than the United States.
Dr. Bastiampillai also presented his research on determining the tipping point of psychiatric bed numbers in South Australia. His research determined that reducing psychiatric bed availability below a critical threshold of 30 public beds per 100,000 population, no matter the availability of private beds, resulted in extreme emergency department boarding of psychiatric patients. However, when bed availability increased above 30 public beds per 100,000 population, emergency department boarding decreased substantially. This indicates that emergency department boarding of psychiatric patients serves as a direct indicator of psychiatric bed availability in South Australia and may be a useful performance measure when determining psychiatric bed targets.
Beyond beds and the need for a full continuum of care
In addition to the presidential symposium on beds, ORPA was represented at the APA annual meeting with a presentation on our October 2017 report, Beyond beds: The vital role of a full continuum of psychiatric care. A joint report with the National Association of State Mental Health Program Directors (NASMHPD), Beyond Beds authors Doris Fuller and Debra Pinals, MD, outlined the contents of the report and went through each of its ten recommendations.
The message was clear: inpatient psychiatric beds are a necessary part of the vital continuum of psychiatric care, but they alone are not sufficient to ensure timely and effective treatment for individuals with the most severe psychiatric diseases.
More inpatient beds are necessary to improve access for individuals with serious mental illness in need of such level of intensive care. This is evidenced by psychiatric patient boarding in emergency departments throughout the country and the fact that nearly half the states are in contempt or under threat of legal action due to their forensic bed waits.
However, in addition to more beds, several additional steps must be taken to ensure effective treatment for these individuals. For example, the report encourages the utilization of pre-arrest diversion programs to reduce the criminalization of mental illness, increases in psychiatric training programs to address the extreme psychiatric workforce shortages, and the fostering of information sharing across systems to ensure proper linkages between care levels.
Elizabeth Sinclair
Director of Research
References:
- Allison, S. et al. (2015). Mental health services reach tipping point in Australian acute hospitals. Medical Journal of Australia.
- Pinals, D. et al. (2018). Beyond beds: The vital role of a full continuum of psychiatric care. American Psychiatric Association Meeting.
- Sharfstein, S. et al. (2018). Tipping point: The critical decline in psychiatric hospital beds. American Psychiatric Association Meeting.