Hospital bed shortages are 'trapping' mentally ill patients in EDs

As hospitals face inpatient bed shortages, psychiatric boarding — making patients who need psychiatric treatment wait for prolonged periods in emergency departments because of mental health resource shortages — has become a particular problem for mentally ill patients, Nathaniel Morris, MD, physician in psychiatry at Stanford (Calif.) University School of Medicine, writes in The Washington Post.

Here are five insights from the op-ed.

1. Dr. Morris frequently is forced to tell patients who need psychiatric care that the hospital does not have an open bed. A 2016 survey echoes Dr. Morris' experience, with nearly three-fourths of emergency physicians reporting psychiatric patients had been waiting for beds during their last shift.

2. Despite the long waits psychiatric patients face for hospital beds across the country, "community mental health resources have failed to keep up with surging demand, leading many psychiatric patients to turn to emergency departments for care," Dr. Morris wrote. Dr. Morris cited data from the Agency for Healthcare Research and Quality, which found ED visit rates for depression, anxiety, bipolar disorder and psychotic disorders jumped by over 50 percent between 2006 and 2013. 

3. "This combination — falling numbers of psychiatric hospital beds, coupled with rising use of emergency departments by psychiatric patients — has made psychiatric boarding commonplace across the country," Dr. Morris wrote. "Every day, patients suffering from psychiatric crises are trapped in emergency departments, too sick to go home but with nowhere else to go."

4. The design of EDs can worsen patients' psychiatric crises, Dr. Morris said. EDs are often crowded, loud and lack privacy. "It's an unnatural environment, frequently without windows, sunlight or plants," he added.

5. To address this issue, Dr. Morris offered several solutions. One is for hospitals to use existing psychiatric beds more efficiently. For instance, CMS recently revised its policies to permit payments for Medicaid patients to receive short-term treatment in certain mental health facilities, which could speed up discharge planning and free beds for other patients. Hospitals also can work to strengthen psychiatric care in EDs by embedding more psychiatrists and psychologists and can begin using telepsychiatry services for patient virtual visits.

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