Opinion: Bed shortages at psychiatric hospitals an elephant in the room

Mark Reinstein
The Caro Center psychiatric facility

Michigan has a tremendous shortage of state-operated psychiatric hospital beds. This is a major reason our mental health system is in crisis, and why some of our most severe mental illness cases cycle repeatedly into difficulty, including justice system incarceration, homelessness and early mortality. Did you know persons with serious mental illness live 25 years less than the population-at-large?

We only have three state-operated hospitals left for adults, and just one for children. The Treatment Advocacy Center (Virginia) says we’re one of the nation’s five worst states when it comes to per capita state-operated adult psychiatric hospital beds for mental illness. With only one such hospital for youth, we can’t be much better in that regard either. And the lack of these resources is just part of the problem.

Because demand is above capacity at the state’s Forensic Center — involving psychiatric assessment, treatment and housing of some criminal cases — our three adult psychiatric hospitals are at least half-filled with forensic inpatients, with a lengthy waiting list existing for admissions.

For decades, as Michigan closed most state-operated psychiatric hospitals, the state has relied on private psychiatric hospitals and psychiatric units in community hospitals for inpatient care. That has been misguided. We have 27% fewer such beds than we did 25 years ago. These hospitals often don’t want inpatients with combative behaviors or histories, and the average length-of-stay in such facilities is less than a week — something my agency documented in a survey five years ago.

For most persons with active symptoms of severe mental illness, less than a week in a hospital is not enough time for appropriate stabilization. Rather, we heavily medicate inpatients and then send them on their way, with or without links to step-down community service. And too often, the medications that were given in the hospital are ignored and discarded.

Michigan presently has around 750 state-operated psychiatric hospital beds. Twenty years ago, when we had about 960 and the federal government reported we used such beds at less than half the national average, major statewide advocacy and professional groups concluded that Michigan needed at least 400 more such beds, split evenly for adults and children. Using that criterion, we need 600 more today.

State-operated psychiatric beds are the only ones where someone can get an intermediate-length or longer-term stay. This was partly recognized in 2013 by then-Lt. Gov. Brian Calley’s Mental Health and Wellness Commission, when it recommended: “Authorize intermediate care beds for both juveniles and adults with a mental illness. Care beds should be made available on a regional basis for stay periods (up) to 30 days and incorporate substance and alcohol use disorder as well as mental health issues.”

Without intermediate and longer stays available, we continually shuttle people in and out of short hospital stays, or none at all, without any long-term improvement and stability.

Most people with mental illness, including me, don’t need hospitalization. And I don’t want anyone in a psychiatric hospital if it’s not needed. But for some of the most severe cases, our current scientific limits leave no other recourse at times. To continually shuttle those cases in and out of short-term hospital stays is cruel, unproductive, and a major cost to society.

Are we so deficient on hospital beds compared to the rest of the country because our community care system is so outstanding and superior to everyone else’s? Absolutely not. Our leaders simply haven’t wanted to spend the money needed, and some of our constituents at certain points in their lives cannot benefit from non-hospital care.

This is the elephant in the room that most people don’t want to acknowledge. But our mental health system will remain in crisis if we don’t. Yes, it will cost money. If we aren’t willing to prioritize more funding for something as critical as this, what kind of a state are we?

Mark Reinstein is president & CEO of the Mental Health Association in Michigan, a Lansing-based statewide advocacy organization.