By Andy Miller, Kaiser Health News -
NBC News
Many mental health crisis patients have to wait several days in emergency rooms for beds to become available at one of Georgia's five state psychiatric hospitals, as public facilities across the country are affected by the coronavirus pandemic. .
"We are in crisis mode," said Dr. John Sy, an emergency room physician in Savannah.
“Two weeks ago, we probably had eight to ten patients.
Some had been there for days, "he added.
The shortage of beds in Georgia's state psychiatric facilities reflects a national trend linked to staffing shortages that are hampering services in the public mental health system.
The problem of bed capacity, which has existed for years, has worsened during the pandemic, creating
a backlog of poor or uninsured patients, as well as people in prisons
waiting to be admitted to state centers.
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Many state workers, such as nurses, are leaving psychiatric units in search of much higher wages - in temp agencies or other employers - and less stressful conditions.
Staff resignations have limited the ability of state psychiatric units
to care for patients, who are often poor or uninsured, forcing some seriously mentally ill people to languish in hospital emergency rooms or in prisons until beds being opened in state systems, according to local leaders of the National Alliance on Mental Illness.
"These patients are sometimes tied up or kept in isolation and often receive little or no mental health services," said Roland Behm, a member of the board of directors for the Georgia chapter of the American Foundation for Suicide Prevention.
An unprecedented mental health crisis
Nationally, the shortage of beds and mental health workers has collided with a growing demand for people in need of treatment in the wake of the pandemic.
"Emergency rooms have been flooded with patients needing psychiatric care," said Dr. Robert Trestman, president of the Council on Health Systems and Funding for the American Psychiatric Association.
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"The current crisis is unprecedented in terms of the extent, severity and scope of its national impact," he remarked.
Virginia has drastically reduced admissions to state psychiatric hospitals due to staff shortages as demand for services increases.
"I've never seen such a big bottleneck across the system,"
said Kathy Harkey, executive director of the Virginia chapter of the National Alliance on Mental Illness.
The pressure is spreading to the private system, he added.
A Texas advisory committee reported in July that there were a near-record number of people on the waiting list for beds in state hospitals for forensic patients, that is, people involved in the court system who suffer from mental illness.
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Last month, National Guard soldiers returned to Oregon's largest public psychiatric facility to reinforce the workforce.
In Maine, a committee of criminal justice and mental health officials has been working on adding state psychiatric beds and finding places for people who need treatment for mental illness but are being held in prisons.
Those with good insurance can usually choose private centers or general hospital psychiatric wards, Trestman said.
But in many cases, those beds are also full.
Dr. Brian Hepburn, director of the National Association of State Mental Health Program Directors, said that, like the medical system in general,
the mental health system is "under great pressure
.
"
The staffing shortage is especially dire in hospital or residential mental health centers, he said, and the pressure extends to private providers.
States are focusing on suicide prevention and crisis services to reduce the impact of the crisis on emergency rooms and inpatient services, Hepburn said.
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In Georgia, about 100 beds in the state's five psychiatric hospitals - about 10% - are empty because there is no one to take care of the patients who could occupy them.
Space in short-term crisis units is also at the limit.
The turnover rate for hospital workers was 38% last fiscal year, according to the state Department of Mental Health and Developmental Disabilities.
Melanie Dallas, CEO of Highland Rivers Health, which provides mental health services in North Georgia, said that beyond hospitals, the challenge of meeting increased demand with such a small number of staff is unprecedented. in its 33 years in the sector.
"Everybody is exhausted," he
said.
Nationwide, many nurses and other mental health workers have left their jobs in state institutions.
It's “tough and exhausting work
,
”
explained Hannah Longley, community program director for the Maine chapter of the National Alliance on Mental Illness.
State work also does not offer "a meaningful salary and benefits package," he said.
A nurse at a state hospital in the United States typically earns $ 40 to $ 48 an hour, while at a temp agency she can earn $ 120 to $ 200, Trestman explains.
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"A lot of people are looking to make money from the pandemic," said Netha Carter, a nurse who works at an Augusta, Georgia, state center for people with developmental disabilities.
She says that temporary work agencies offer "triple the salary" than state centers, but that she stays because she likes the type of work she does.
Kim Jones, executive director of the Georgia National Alliance on Mental Illness, said she has received increasing calls about people with mental health needs who cannot get long-term hospital services as the delay in care increases.
These waits for care can make the situation worse for patients.
Several years ago, Cameron, Tommie Thompson's son, waited 11 months to get a bed at the Atlanta State Hospital while he was in jail.
"When he got to the hospital, he was totally psychotic
," Thompson said.
The delay in public services is seen in prisons across Georgia, where more people are being kept behind bars because mental health facilities are overcrowded.
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The Georgia Sheriffs Association said its members have relayed their difficulties in assigning people to treatment in state institutions.
"
A lot of these people don't need to be in jail, but they are trapped there,
" said Bill Hallsworth, coordinator of corrections and judicial services for the association.
"There is no place to put them," he said.
Hospital emergency rooms are also feeling the state's bed shortage, said Anna Adams, a senior vice president of the Georgia Hospital Association.
Robin Rau, general manager of Miller County Hospital in rural southwestern Georgia, said people with mental illness who come to the ER "tend to be at the end of the line."
Rau said the wait for available beds is horrible.
"The coronavirus has aggravated everything," he said.