Severe Lack of Psychiatric Resources in the US

National Institute of Mental Health Clinical Center (Photo credit: Wikipedia)

From a Military Health Matters! blog item by Karen Estrada, MS

This is a brand new published interview-series (7 parts), with psychiatrists Dr. Joe Parks, Dr. Richard H. Weisler, and Dr. Henry A. Nasrallah on the magnitude, impact, and means of addressing this critical situation. I highly recommend not only reading this synopsis but to read through the entire series as well.

Summary:

• Evidence shows that this country is short 45,000 psychiatrists.
• According to the National Association of State Mental Health Program Directors (NASMHPD),[3] mental health spending dropped 5% from 2009 to 2010 and it is predicted to go down another 8% in 2011.
• The National Alliance on Mental Illness study in North Carolina found that there were 3000 people on a waiting list for admission in only the first 6 months of the year; 212 people out of 3000 waited more than a week and 900 just quit looking — they just left.
• References.

Editor’s Note:

“The United States is facing a severe lack of psychiatric care resources. Given the current economic crisis, the problem is only getting worse as state budgets for mental health care continue to be cut.”

Evidence shows that this country is short 45,000 psychiatrists.

At times of stress, like we have had in the last few years with the economy, there is an increase in psychiatric demand, particularly in terms of depression, anxiety, suicidality, and drug abuse.

The seriously mentally ill patients are not well served for numerous reasons. Beyond just a lack of resources, the system is a problem unto itself.

Psychiatry is the number-one area in which more professionals are needed.

According to the National Association of State Mental Health Program Directors (NASMHPD),[3] mental health spending dropped 5% from 2009 to 2010 and it is predicted to go down another 8% in 2011.

Is the Economy to Blame?

“The economy is an easy scapegoat for the recent decline in mental health resources, but it sounds like the consensus is that the system has been at least partially broken for quite a while. “

The single biggest cause of suffering for many of our patients is that they cannot be admitted to a hospital when they relapse during medical treatment. According to a 2010 report by the Treatment Advocacy Center,[4] there was 1 bed per 300 people in the United States in 1955; currently, we have 1 bed for every 3000 people.

Maldistribution.

There are wide variances in overall funding for mental health resources, whether it’s hospital beds or community resources. There are huge maldistributions in terms of psychiatrists per 100,000 people.

There are about 3 or 4 times the number or psychiatrists in New York or Massachusetts per capita, compared with states like Texas. There are fewer psychiatrists for severely ill patients than it appears because only a small percentage of them are really seeing the very sick patients. Relatively few psychiatrists choose to work in community mental health centers or state or VA hospitals, where the sickest and most disabled patients are.

The key thing is not to treat patients in isolation, you have to reach out and develop relationships.

The recent removal of consultation codes for Medicare and some other insurance providers may undermine efforts to increase interdisciplinary consultations and collaboration because of reduced reimbursements.

Model of collaborative care.

The primary care of the seriously mentally ill is in this country, especially after the CATIE study found that a large proportion of persons with schizophrenia in the outpatient setting in the United States had their serious medical problems ignored.[11] There is hardly any relationship between community mental health centers and primary care clinics.

The CATIE study showed:

●      60% of patients with schizophrenia who had frank hypertension had never received an antihypertensive drug.

●      90% of those who had high cholesterol or triglycerides had never received a statin.

●      30% of those with clinical diabetes have never received treatment for diabetes.

“This reflects an unconscionable neglect of the physical health of the mentally ill, and it is a result of this lack of bridging between primary care and psychiatry, especially in community mental health centers.”

Prisons: The New Psych Ward.

What are the ramifications of inadequate mental health resources?

There needs to be about 40 beds per 100,000 people, there is only 17 per 100,000. Hundreds of thousands of psychiatric patients are now being sent to correctional facilities.

According to some studies and statistics:

●      35%-54% of prisoners have symptoms of mania.

●      16%-30% have major depression.

●      10%-24% have some psychotic symptoms, such as delusions or hallucinations (Table 2).[4,12]

●      Even more conservative estimates reflect that 16% of prisoners have mental illness.[13]

Many of the people with mental illness have co-occurring substance abuse and disorders, and many of their convictions are substance abuse related.  Prisons are releasing to the community people with chronic mental illness; this only predisposes them to repetitive rehospitalization for psychotic and manic episodes due to poor adherence or, more likely, incarceration.

Emergency Rooms.

The ER is where everybody goes when they have a medical illness but no primary care provider, and the same thing happens with the mentally ill.  A substantial number of those who present to the ER have a mental illness.

The National Alliance on Mental Illness study in North Carolina found that there were 3000 people on a waiting list for admission in only the first 6 months of the year; 212 people out of 3000 waited more than a week and 900 just quit looking — they just left.[15]

Is Healthcare Reform the Answer?

By improving the reimbursement for mental illness — the hospitalized mentally ill — would definitely incentivize hospitals to stop closing those units and maybe even to open new ones.

A report entitled “Recommendations to Foster System Reform for Adults With Serious Mental Illness,”[16] identifying 5 key priorities for legislative, policy, and program implementation as part of National Health Reform.

The 5 key priorities are:

●      Developing a set of performance measures specific to treatment of mental illness.

●      Designating persons with mental illness a health disparities population.

●      Including mental health treatment providers in federal funding and policy related to health information technology initiatives.

●      Making sure that the new healthcare home initiatives adequately address mental illness.

●      Developing a national definition of “medical necessity” that adequately meets the needs of persons with mental illness.

References

1. Konrad TR, Ellis AR, Thomas KC, Holzer CE, Morrissey JP. County-level estimates of mental health professional shortage in the United States. Psychiatr Serv. 2009;60:1323-1328. Abstract
2. President’s mental health commission recommends transforming America’s mental health care system. Mental Health Commission Web site. Available at: http://www.mentalhealthcommission.gov/press/july03press.htm. Accessed September 13, 2010.
3. As economy takes toll, mental health budgets shrink. Stateline Website. Available at: http://www.stateline.org/live/details/story?contentId=499181. Accessed September 3, 2010.
4. Torrey EF. More mentally ill persons are in jails and prisons than hospitals: a survey of the states. Available at: http://www.treatmentadvocacycenter.org/storage/tac/documents/final_jails_v_hospitals_study.pdf Accessed September 3, 2010.
5. Wing JK. How many psychiatric beds? Psychol Med. 1971;1:188-190.
6. Goplerud EN. Assessing methods of predicting the need for psychiatric beds. Hosp Community Psychiatry. 1986;37:391-395. Abstract
7. Häfner H. Do we still need beds for psychiatric patients? An analysis of changing patterns of mental health care. Acta Psychiatr Scand. 1987;75:113-126. Abstract
8. Hirsch SR, Gerrard B, Malin H, et al. Psychiatric Beds and Resources: Factors Influencing Bed Use and Service Planning. Report of a Working Party of the Section for Social and Community Psychiatry of the Royal College of Psychiatrists. London: Gaskell; 1988.
9. Davis GE, Lowell WE, Davis GL. Determining the number of state psychiatric hospital beds by measuring quality of care with artificial neural networks. Am J Medical Quality. 1998;13:13-24.
10. Hagedorn H. A Manual on State Mental Health Planning. NIMH, DHEW Publication No. ADM77-473. Washington, DC: U.S. Government Printing Office; 1977.
11. Nasrallah HA, Meyer JM, Goff DC, et al. Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophr Res. 2006;86:15-22.Abstract
12. Kuehn BM. Mental health courts show promise. JAMA. 2007;297:1641-1643.Abstract
13. Lamb RH, Weinberger LE. The shift of psychiatric inpatient care from hospitals to jails and prisons. J Am Acad Psychiatry Law. 2005;33:529-534.Abstract
14. Swartz MS, Swanson JW, Wagner HR, Burns BJ, Hiday VA, Borum R. Can involuntary outpatient commitment reduce hospital recidivism?: Findings from a randomized trial with severely mentally ill individuals. Am J Psychiatry. 1999;156:1968-1975.Abstract
15. Biesecker M. Mentally ill often turned away, end up in ER. Raleigh News and Observer. August 7, 2010. Available at:http://www.newsobserver.com/2010/08/07/618475/mentally–ill–often–turned–away.html Accessed September 13, 2010.
16. National Association of County Behavioral Health and Developmental Disability Directors. Recommendations to Foster System Reform for Adults With Serious Mental Illness. Available at:http://nacbhdd.org/content/Fostering%20System%20Reform%209-8-10.pdf Accessed September 14, 2010.
17. Pies R. “Prescribing psychologists:” practicing medicine without a license? March 29, 2010. Psychiatric Times. Available at:http://www.psychiatrictimes.com/geriatric–psychiatry/content/article/10168/1545667 Accessed September 15, 2010.

SOURCE

Stetka B. “US Psychiatric Resources: A Country in Crisis” September 22, 2010. Medscape Psychiatry & Mental Health. Available at: http://www.medscape.com/viewarticle/728676 [Accessed 22 Sept 2010].

Please See More: Severe Lack of Psychiatric Resources in the US  – Today on Milhealth’s Directory – MHD http://www.milhealthsdirectory.org/today-on-milhealths-directory/severe-lack-of-psychiatric-resources-in-the-us.html#ixzz10ivE2ipf
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