Wednesday, March 07, 2012

Where Did All The Psych Beds Go?



Roy likes to write about Emergency Departments and Bed Availability for psychiatric patients, but this one came to me, so I'll borrow the topic while he's away.


In the Observer-Dispatch in NY State, Andrew Coates writes in "Guest View: Psych ward closings require public discussions":


The pell-mell closures of inpatient wards at Mohawk Valley Psychiatric Center and at other Office of Mental Health (OMH) facilities around the state are unfair and unwise. The cuts will shift costs to localities even as they rob the same communities, especially Utica, of much-needed jobs.

New York state law formerly required a full year of public notification when OMH planned to close or downsize inpatient services.
But last year, Gov. Cuomo wrote into the state budget a provision that authorized ward closures on 30 days’ notice and facility closures on 60 days’ notice.
 
Coates goes on to say that the Governor has chosen "expediency over community needs.

It may be politically expedient to turn a deaf ear and a blind eye to needs of patients with serious mental illness. (Patients who are not exactly known for lavish campaign contributions!)
Yet cutting services to vulnerable patients with no serious public discussion of the impact on our communities, with no regard for the human hardship upon patients and their families, is as irresponsible as it is outrageous.


 In the next day's (2/29) Times Union, Dr. Coates then shared a patient's perspective on the bed closures.  The patient wrote:


For many individuals in Mohawk Valley, no one is really sure where they are going. But they are leaving maybe the only home they ever knew. Maybe the only place they ever felt safe.

Mohawk Valley is not perfect but it’s certainly better than the streets. And now the system has failed them – the system itself is failing. The mental health system is stretched to the breaking point already in NYS. Closings are just going to make it worse. People are going to end up on the street.

 I'll leave the comments to you.  I probably would have found the patient's opinion to be more powerful if she had been previously hospitalized in the facility that is being closed.  


Thanks to Meg for the shout out on this issue!

11 comments:

jessa said...

Didn't this already happen once, in the 1970's, to disastrous effect? We already know that I'm strongly against inpatient treatment, but I wish there were more halfway houses and assisted living sort of situations for these people.

And my immediate reaction to the political expediency of ignoring those with mental illness: What the f*** is wrong with these people? But that is my reaction to almost everything in politics these days.

rob lindeman said...

What we mean by "enough beds"? It's a serious question: Are there enough beds for everybody who WANTS a psyche bed? The answer to that question might very well be 'yes'. If, however, the question is 'Are there enough beds for everybody WE want to put in a psyche hospital?' clearly the answer is 'no'.

This is not so much a mental-health care delivery problem as it is a housing problem. Societies outcasts, outliers, and unwanted basically have psyche hospitals and prisons in which to live. Some choice. We can do better

Sarebear said...

I know that area of New York suffered a severe economic downturn (much more severe than some other parts of the country; for example, IBM, a major employer in the area, seemed to employ about half the town I grew up in, closed/pulled out much of their presence in some areas). I used to live there and we kept in touch with some people from back there.

It's only been the last couple years that the area has been coming out of this big hit that started in 89 or 90.

So the tax base went to heck a while ago, maybe they are reluctant to spend money on a problematic region, I dunno.

Just thought what I knew would add some flavor or background to this.

Anonymous said...

Rob,

I have never wanted a psych bed. I will never want a psych bed. At times, I have needed a psych bed. I do not know what will be in the future. I am not an outcast. Perhaps I am an outlier but in ways you would not expect. When I have needed a psych bed, a place where you get some sort of psych treatment, i have usually ended up in a "quiet room" on the ER or shackled to a bed in the hallway with an attendant while waiting for a psych bed to open up. If you try a week of that, you are qualified to talk about a bed shortage. It is real. It is not confined to certain jurisdictions. The problem is widespread. Yes, i do know that if you are dying of cancer you will also probably end up in the hall for a week. And psych beds are not only for the disenfranchised. They are also needed for your kids' teachers, your lawyer, your baby-sitters' aunt and your next door neighbor's son.

Meg said...

On a related note, check this out:
http://www.huffingtonpost.com/2012/03/07/richard-codey-homeless-man_n_1326717.html

George Dawson, MD, DFAPA said...

Also commented on this issue on my blog: http://real-psychiatry.blogspot.com/2012/03/is-it-economy.html

Nothing new here - managed care and managed care strategies in the public sector have been closing down inpatient capacity for at least two decades. They have also moved on to outpatient clinics. Basically systematic bias against anyone who needs mental health services and all because the reimburse,ent for services has always been bad and is currently even worse.

rob lindeman said...

"I have usually ended up in a 'quiet room' on the ER or shackled to a bed in the hallway with an attendant while waiting for a psych bed to open up"

You did not need to be treated so badly. Nobody does.

"Yes, i do know that if you are dying of cancer you will also probably end up in the hall for a week."

No, this is not true. People with cancer are treated extraordinarily well, especially compared to people with mental illness.

"If you try a week of that, you are qualified to talk about a bed shortage."

An argument from experience? No, thanks. I have to be shackled to a gurney in an ER to be able to comment about the shortage of psyche beds? Seriously?

Sophia said...

We've only had one psych unit close down in my neck of the woods in very recent years, but finding a bed is still difficult.

When I worked for a CMH contract agency, we would sometimes need to send people two hours away in order to get them care. A lot of people went voluntarily, but there were people that were certified. It was easier to get the certified folks in to a local hospital.

People who went voluntarily and managed to get in locally were frequently discharged before they could be called "stable." (Not a fan of that word, personally) Naturally, the short hospitalization times were hailed by the state as a standard.

Most people don't care to go to the hospital. The beds are uncomfortable, your room isn't particularly wellness-inspiring compared to say, the maternity rooms, there isn't a lot to do - and what there is to do is kind of lame - and you don't a lot of freedom even if you're not a "risk." (Another word I'm not a fan of) The hospital sucks, but it's necessary.

Even facilities equipped for long-term treatment treat the short-term. At least our state hospital did until budget cuts and now they only take people deemed to need long-term treatment. Kind of a blow to my area, considering they have the best inpatient providers. C'est la vie.

Anonymous said...

No, Rob. I did not want to be treated so badly. That is just the current reality of lack of beds and staff ing shortages.. Re: cancer patients, I know , from experience, that if there is no bed, there is no bed, cancer or no cancer. Beds seem to be alloted to cancer patients based on prognosis. If you are dying, you can stay in the hallway unless there is a palliative bed. If you are young with a decent prognosis, you are more likely to get the bed. You work in pediatrics. I work in geriatrics. That qualifies me.

An argument from experience? Yes. if you have not been there, don't pretend to know. If you have not read the book or seen the movie, don't write a review. I live on both sides and I do not speak for everyone, everywhere. I can speak for myself as a patient, based on a number of experiences. I can also speak as an "insider" in the health field, at least in my locale.

J said...

I don't know, I really don't find the "emotional" argument convincing. First, this particular "emotional" argument simply wasn't that moving. That said, I really don't think "arguments" of that sort are going to make for any sort of policy reversal or amendment, and frankly, I don't think they should. Look at the numbers, look at the economics, see what best serves the largest number of people. I hate to say it, but that is reality. And just because a patient thinks fondly towards the psych bed....seriously?

And yes, anon, I was hospitalized in a NYS hospital, multiple times. Sometimes I received good care, sometimes I did not. I once asked for the care; but when I asked to leave, that was not permitted. Rob makes a valid point - the number of beds wanted vs the number needed vs the number "we" decide is needed. I will also make the point that a psych ward is not an appropriate means of dealing with homelessness or drug addiction, which we see right left and center here in nyc.

Perhaps closing these wards is not the best answer. But not because some old patient thinks fondly towards it, and not because new beds will need to be found for homeless men and women. Analyze - honestly - the spending and see where it belongs. Maybe more homeless centers are needed, not psych wards. Maybe more addiction programs are needed, not psych wards. Who knows. There isn't enough relevant data available to the public for us to begin to hazard a guess.

Anonymous said...

This closure is not about saving money!!! It will cost Hutchings 19 billion dollars to bring it up to codes! Hutchings does not even have a fire sprinkler system in place!!' The buildings have not been in use.,,the walls are haunted looking ald the plaster is crumbling and asbestos is in the walls!! Universit Hosital will buy it for more than that!!!the facility was built on a highway with no grounds! Cost of Moving to MVPC 0$$$$$