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Psychiatric Treatment Facilities Fall Short of Need for Mentally Ill Americans

Another shortage that is creating a health care crisis is a lack of space in psychiatric facilities for people with serious mental illness. Over the last few decades many psychiatric hospitals have closed. We have gone from half a million beds in such facilities to less than 100,000 today.

Although the expectation may have been that the mentally ill would receive treatment in their communities, there has not been adequate development of local mental health treatment centers. This is true in virtually every state.

As a result, patients are shunted to emergency rooms that are ill-equipped to handle the onslaught of psychiatric emergencies. Patients without insurance may not be admitted to private facilities. Because mental illness makes it more difficult to maintain a job that carries insurance, this puts the mentally ill in a difficult Catch-22. Even with the Affordable Care Act, there are no quick solutions to this public health emergency.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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As a parent of a son with mental illness I can also say the psychiatrists my son has seen do not really screen them well, ask a few questions and then hand out the meds. Many of which are too strong for the mildly schizophrenic patient after the patient was seen for less than ten or fifteen minutes. My son has had five different diagnoses and when I have tried to explain my son’s symptoms and behavior, I am dismissed as an over-reactive mother.
He has lived with me for fifteen years and was diagnosed at the age of 31 with major depression with psychotic features. He has seen four psych Drs. since and has not had the same diagnosis from any of the four. Some of the meds he has been given have made him zombie like and yet one Dr wanted to increase the dosage. It is a disgraceful situation.

With money so tight, facilities seek every possible way to save $$$ and this certainly includes staffing reductions. THEREFORE, even if the person in distress can find a bed, s/he will receive precious little counseling or patient education re the precipitating problem. No time for counseling at all! Instead, they snow the patient with drugs and provide a “safe, secure environment” and little bit of personal support and attention. Removed from everyday stresses, the patient soon appears “better” and is pronounced so and then released — equipped with precious little if any of what s/he needs to gain greater control and/or avoid a repeat of the problem situation.
The ONLY way to get much attention at a psych facility is to act out, i.e., to be so low-functioning that staff “attention” can accomplish little more than keep the place “safe,” i.e., keep the patient from doing harm to self/others. This is a liability issue for the facility and accomplishes very little in terms of clinical intervention. But truly, with the low staffing ratios (and inability to hire/pay reasonably skilled clinicians) that’s the best that 99% of inpatients can anticipate.
The higher-functioning but still impaired patients, who could indeed have benefited from the inpatient experience, leave empty handed and thus more distraught/helpless feeling than ever. Worst of all, the staff who might in fact have some extra time for one-on-one intervention are so impaired by “habituation to stimulus” that they’re long past getting very motivated to spend that time working creatively with the patients.
No wonder inpatient recidivism rates, and dysfunction in the general populace, is so horrible and getting worse by the day! (By the way, I’ve worked in inpatient psych facilities for 25 years and you can take these words to the bank and cash ’em.)

That is certainly true; private hospitals often find psych wards unprofitable. But the greatest number of closures have been the state hospitals that serve Medicaid and uninsured patients (which as the article points out, are most of the folks with severe and persistent mental illness). When anti-psychotics came along there was unwarranted hope that they were the cure-all and everyone could now live and be treated in the community.
At the same time there was a public outcry against the awful conditions in many of the state hospitals, and a civil liberties movement that rightly made involuntary commitment much more difficult (though it can be argued that it went too far). State governments saw an opportunity to save millions and began downsizing and/or closing their state mental institutions. Some states now have no public mental hospitals at all, instead paying for private hospital beds, of which there are too few. As you point out many of those have also been cut, and both factors have contributed to our current shortage. Exacerbating the shortage is the fact that private hospitals can and often do cherry-pick their patients, refusing those they deem “undesirable” (e.g. especially difficult patients or those with other medical conditions).

I am a Psychotherapist who work in a Psych hospital. I think we need to view mental health more in terms of community care than large state hospitals. After discharge, many patients have no intensive outpatient facilities in their community and so do not follow-up with the critical after care. Maybe we need to focus on having smaller mental health clinics that provide intensive counseling and medication management, make the credentialing policy less arduous and allow more licensed clinicians the opportunity to provide these services.

In many cases, it was not psychiatric hospitals that were closed — but psychiatric wards in general hospitals.

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