Understaffed state psychiatric facilities leave mental health patients in limbo

Many patients dealing with mental health crises have to wait several days in emergency rooms for beds to be available at one of Georgia’s five state psychiatric hospitals as public facilities across the country feel the crisis of the coronavirus pandemic.

“We are in a crisis situation,” said Dr. John C., an emergency physician in Savannah. “A couple of weeks ago, we were probably seeing eight to ten patients. Some of them have been there for days.”

The shortage of beds in state psychiatric facilities in Georgia reflects a national trend of understaffing that leads to diminished services in the public mental health system. The family capacity problem, which has been around for years, has worsened during the pandemic, leading to a buildup of poor or uninsured patients, as well as people in prison waiting to be placed in state facilities.

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Many state employees, such as nurses, leave psychiatric units for much higher pay — with temporary agencies or other employers — and less stressful conditions. Departures have limited the capacity of state-run psychiatric units for patients, who are often poor or uninsured, forcing some seriously mentally ill people to remain in hospital emergency rooms or prisons until beds open in state systems, according to local coalition leaders. National Mental Illness.

“Such patients are sometimes restricted or isolated and often receive little or no mental health services,” said Roland Beh, a board member for the Georgia chapter of the American Foundation for Suicide Prevention.

An unprecedented mental health crisis

Nationwide, shortages in family and mental health workers have collided with increased demand for mental health treatment due to the pandemic.

“ERs are overwhelmed by patients who need psychiatric care,” said Dr. Robert Triestman, chair of the American Psychiatric Association’s Board of Health Care Systems and Funding. He added, “The current crisis is unprecedented in terms of its size, severity and sweeping national impact.”

Virginia has severely reduced admissions to state mental hospitals due to staff shortages while increasing demand for services. “I’ve never seen a complete bottleneck in the system that bad,” said Cathy Harkey, executive director of the National Alliance on Mental Illness, Virginia chapter. She said the tension extends to the private regime.

A Texas advisory panel reported in July that a near-record number of people were on a waiting list for state hospital beds for forensic patients, meaning those involved in the court system with mental illnesses.

Last month, National Guard soldiers returned to Oregon’s largest public psychiatric facility to support the workforce.

In Maine, a panel of criminal justice and mental health officials is working to add psychiatric beds and find places for people who need treatment for mental illness but are incarcerated.

Those who are well insured can usually choose private facilities or psychiatric wards in public hospitals, Triestman said. But in many cases, this family is also full.

Like the medical system in general, the behavioral health system “is under a great deal of stress,” said Dr. Brian Hepburn, president of the state’s National Association of Mental Health Program Managers. Manpower shortages are particularly acute in inpatient or residential behavioral health facilities, he said, and pressure extends to private providers.

Hepburn said states are focusing on suicide prevention and crisis services to reduce pressure on emergency rooms and inpatient services.

Lots of people are chasing covid money.

In Georgia, about 100 beds in the state’s five psychiatric hospitals — about 10 percent — are empty because no one is caring for the patients who will occupy them. The space in the short-term crisis units has also shrunk. Hospital employee turnover reached 38 percent over the past fiscal year, according to the state’s Department of Behavioral Health and Developmental Disabilities.

Unlike hospitals, the challenge of dealing with high demand with such a declining number of employees is unprecedented in her 33 years in the field, said Melanie Dallas, CEO of Highland Rivers Health, which provides behavioral health services in northern Georgia. “Everyone is tired,” she said.

Nationwide, many nurses and mental health workers have left state jobs.

“It’s hard and exhausting work,” said Hannah Longley, director of the community program at the Maine chapter of the National Alliance on Mental Illness. She said government work does not offer “great salaries and benefits”.

A government hospital nurse in the United States typically makes $40 to $48 an hour, Triestman said, while the rate for a temporary agency nurse ranges from $120 to $200.

“A lot of people are chasing Covid money,” said Nitha Carter, a nurse practitioner who works at a government facility in Augusta, Georgia, for the developmentally disabled. She said temporary employment agencies offer “three times the wages” of state utilities but will stay because they like the kind of work they do.

Kim Jones, executive director of the National Alliance on Mental Illness in Georgia, said she’s been getting more calls about people with mental health needs who can’t get long-term hospital services as the backlog grows.

Such waiting periods for care can worsen patients’ conditions. Several years ago, Tommy Thompson’s son Cameron waited 11 months for a state hospital bed in Atlanta while he was in prison. “By the time he got to the hospital, he was completely psychotic,” Thompson said.

The backlog in public services in prisons is growing across Georgia, as more people are being held behind bars because mental health facilities are overwhelmed.

The Georgia Mayor’s Association said its members relayed the difficulties they face in placing people in state-administered therapy. “A lot of these people don’t need to be in prison, but they are stuck there,” said Bill Hallsworth, prison and court services coordinator for the association. “There is no place to put them.”

Anna Adams, vice president of the Georgia Hospital Association, said hospitals are also feeling a lack of state beds. People with mental illness who make it to the emergency room “tend to be at the end of the line,” said Robin Rao, CEO of Miller County Hospital in rural southwest Georgia.

Rao said the family backlog is horrific. “Covid has just made everything worse,” she said.

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