Sunday, July 22, 2012

NO ROOM AT THE INN Trends and Consequences of Closing Public Psychiatric Hospitals

No Room At The Inn
The number of public hospital beds for people in acute psychiatric crisis plunged in 2010 to levels not seen since 1850, exerting profound impacts on patients, law enforcement, jails, hospitals and public safety, according to a new study released today by the Treatment Advocacy Center.

“No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals” reports that state hospital bed numbers dropped 14% from 2005 to 2010, falling to 43,318 beds nationwide. This compares with 50,509 beds in 2005 and 558,922 in 1955, the peak year of psychiatric hospitalization before the trend known as “deinstitutionalization” began.

The Treatment Advocacy Center called for a moratorium on further public hospital bed closures until a sufficient number of psychiatric beds for acutely and/or chronically ill individuals is available, either in state hospitals or community facilities.
“The elimination of hospital beds for people who are psychotic or otherwise acutely or chronically disabled by severe mental illness endangers them and society at large,” said Doris A. Fuller, executive director of the Treatment Advocacy Center and a co-author of the study.

“These closures are creating enormous strains on law enforcement, jails, prisons and hospital ERs, where acutely ill people are essentially ‘re-institutionalized’–or left to live on the streets,” she said. “Wherever they are, they exist in an alternate reality that deprives them of the ability to participate in life as they could with treatment.”
Nationwide, only 14.1 public hospital beds remained for each 100,000 people by 2010, the latest year for which data is available. The bed population has not been this low since 1850, when it was 14.0. A minimum of 50 beds per 100,000 is a consensus target for providing minimally adequate treatment to the public.

Among other consequences, the study found a statistically significant inverse association between lower state-hospital spending and higher numbers of arrest-related deaths. States that closed more public psychiatric beds between 2005 and 2010 appeared to experience higher rates of violent crime in general and of aggravated assault in particular.

Thirteen states were found to have closed 25% of their psychiatric beds during the five-year period, with two states–New Mexico and Minnesota–eliminating more than half their public beds. After its most recent closures, Minnesota provided only 3.9 beds per 100,000 people.   

Ten states added beds but continued to offer less than half the number of beds considered necessary to provide minimally adequate psychiatric care. Nevada, for example, increased its bed population by 60% but still provided only 11.2 beds per 100,000 people.

State hospital beds are reserved primarily for individuals with acute or chronic severe mental illness who meetstate criteria for civil commitment. In most cases, they cannot seek treatment voluntarily because they do not recognize they are ill, a neurological condition known as “anosognosia.” In some states, public beds numbers are reduced further because many of those remaining are reserved for forensic patients who have committed crimes.

The Treatment Advocacy Center is a national nonprofit organization dedicated to the elimination of legal and other barriers to the treatment of severe mental illness.

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