As we wrote about in our August 2019 blog, “What are the consequences of an inadequate number of long term public psychiatric inpatient beds?“; we seem to have no shortage of short term stay private pay psychiatric hospitals, but we still lack the long-term public beds. Until we repeal the IMD exclusion, there will be no motivation to ensure that patients that need longer stays in the hospital will be permitted to remain in the hospital. Utilization managers apply pressure to discharge patients to outpatient treatment. There is also an undercurrent of belief that anytime someone needs hospitalization, it is a failure on the part of the outpatient treatment team. Unfair access to hospitalization, when in a behavioral health crisis to appropriate admissions, seems to be a parity issue.
Let’s look at a medical model of a physical lifelong disease process. A person who is obese and has type two diabetes may require readmission to a hospital for re-regulation of their treatment for their disease.
Uncontrollable insulin levels may be due to one of the following reasons:
a) the patient not taking medications as prescribed,
b) eating sugar despite warnings, or c) generalized signs of changes in their metabolic system.
Upon patient stabilization in the hospital, the outpatient treating physician is not penalized for the initial admission.
Why is mental health inpatient treatment any different than medical inpatient treatment for physical diseases?
Isn’t the head part of the body?
This is a parity violation!
Phoenix to get new psychiatric hospital, but some say it won’t fill the need
Chase Hunter, Arizona Republic Published 6:00 a.m. MT Sept. 20, 2019 | Updated 8:36 a.m. MT Sept. 20, 2019
The Phoenix area is in desperate need of more in-patient hospital beds for individuals with psychiatric needs, mental health workers say.
But some fear the new $19.5 million, 96-bed private Phoenix Medical Behavioral Hospital opening in central Phoenix next spring won’t be the solution.
Caliber, a development company, bought the building at 14th Street and McDowell Road for $10 million and is putting $9.5 million into renovations. NeuroPsychiatric Hospitals will run the facility, company spokesman Jim Hummer said.
Hummer said the hospital will only treat adults and expects a majority of its patients will come from senior living facilities. The company owns similar facilities in Indiana.
Some in the mental health community question whether the new hospital will effectively serve the community given the long-term care patients with chronic mental illnesses require.
Psychiatric beds in the Valley
There are currently 433 licensed, state-run in-patient psychiatric beds in metro Phoenix, according to the Maricopa Integrated Health System. An additional 144 beds are slated to be available by April 2020 at Maryvale Hospital in Glendale.
Even with the additions, Phoenix is still in need of in-patient psychiatric beds, health care officials said.
“Everything that I’ve read indicates that Phoenix has a lower than typical number of beds for the population that we have,” said Dr. Gene Cavallo, vice president of the Maricopa Integrated Health System. “For a metropolitan area of this size, we still have a need for more.”
The Treatment Advocacy Center released a report in 2016 on the number of state psychiatric beds in every state and the District of Columbia per 100,000 people.
Arizona ranked fourth worst in the nation, with 4.4 beds available per 100,000 people.
Caliber offers private beds
The beds opening up at the Caliber-owned hospital will be for voluntarily-admitted patients.
These patients may have public or private health insurance. The difference, however, is there is no court mandate or petition that forces someone to enter Phoenix Medical Behavioral Hospital like the patients publicly-operated hospitals must take.
Unlike other private hospitals, Hummer said, Phoenix Medical Behavioral Hospital will have a two-armed approach in its treatment, part medical and part therapy. He said patients are usually treated with medication, but this hospital will also have a team of psychiatrists and therapists who will be there to help patients.
But even that won’t meet the Valley’s needs, one mental health advocate said.
Meeting community’s needs
Charles “Chick” Arnold has been a mental health lawyer working with Valley families of people who are mentally ill for more than 30 years. Arnold successfully sued Arizona in 1989, alleging that Maricopa County did not provide a comprehensive community mental health care system as required by the state.
There are two types of people with mental illnesses who may need a psychiatric hospital, Arnold said. And their needs are quite different.
The first type is those who’ve suffered a momentary mental health crisis, like environmental depression or a psychotic episode, Arnold said. Such people may need admittance to a hospital for short period of time, roughly 30 days, because their illness can be addressed relatively quickly.
“The time someone needs to spend in the hospital is based on a number of factors: quick response to meds, social and family support, and a plan for when they’re ready to leave the hospital.” Dr. Gene Cavallo, vice president of the Maricopa Integrated Health System
The second type is people with mental illnesses such as clinical depression, schizophrenia or bipolar disorder. These people may need to be admitted to a psychiatric facility for a longer period of time and their illnesses are a lifelong struggle.
“The time someone needs to spend in the hospital is based on a number of factors: quick response to meds, social and family support, and a plan for when they’re ready to leave the hospital,” Cavallo said.
The new hospital will focus on those acute mental illnesses and patients will typically stay in the facility for less than a month, Hummer said.
“People that come to us are in a crisis situation, so they’re either threatening to harm somebody, harm themselves, they may have hallucinations, they may be psychotic,” Hummer said. “One we get them back to their baseline of where they have been before all of these things happened, that’s when they’re discharged from the hospital. Our average length of stay is anywhere between 15 to 21 days.”
Arnold said the real need is with that second group. Without more long-term beds for them, they will continue to cycle in and out of the Phoenix area’s jails and emergency rooms, Arnold said.
“Do we need more beds?” Arnold asked, “Well, we don’t need these kind of beds.”
“What they’re offering is short-term hospital space for people who have substance abuse or behavioral health issues,” Arnold said. “There are a lot of private hospital options that, frankly, don’t generally serve this particular population very well in the absence of any type of follow up.”
Laurie Goldstein, vice president of the Association for the Chronically Mentally Ill in Arizona, has a son with schizoaffective disorder who went through many short-term facilities on his way to a healthy life.
About 40% of people with psychotic disorders don’t recognize they’re ill, she said, complicating a physician’s ability to give them a drug treatment.
“Everything nowadays is very short-term,” Goldstein said. “So I think taking someone, whether it’s public or private, to a psychiatric hospital where they want to tweak their meds for three days or five days, and then say that’ll stabilize them outside — that just doesn’t happen.”
Hummer said NueroPsychiatric Hospitals was contacted by health care people in metro Phoenix saying there is a need for a hospital like this one and asking them to help.