Published On Sep 22, 2014
The Lost Ward
Beds for psychiatric care are steadily declining. What can be done?
Last November the son of Virginia State Senator R. Creigh Deeds stabbed his father in the face and torso, then fatally shot himself. Shortly before the assault, the young man, who had a history of bipolar disorder, had been released from a hospital when the emergency department wasn’t able to find an available psychiatric bed.
The Deeds case illuminates a precarious shortfall in inpatient psychiatric care, according to Doris Fuller, executive director of the national nonprofit Treatment Advocacy Center: “This is a dramatic illustration of something that’s happening every day.” While there were once more than 500,000 beds for the mentally ill nationally, the number has dropped steadily over the past 50 years. A movement to deinstitutionalize care beginning in the 1960s and the wider availability of medications are partly responsible. More recently, there has also been a decreased willingness by government and private payers to shoulder inpatient costs.
Patients with severe mental illness now increasingly turn up at hospital emergency rooms, which are often ill-equipped to diagnose or care for them. Others are more likely to end up in prisons or on the street than in a ward or hospital.
The crisis is forcing a conversation about solutions, usually in the form of expanded outpatient care. “There’s a new urgency at the federal, state and local levels to do something about it,” Fuller says.