SHERMAN OAKS -- The number of psychiatric beds in public
hospitals has fallen dramatically across California and the nation
-- with the Golden State now dedicating just 17 beds for mentally
ill patients for every 100,000 residents, according to a newly
released report.
While the ratio in California mirrors the national average, it
represents a sharp drop over the past five decades -- from 340 beds
per 100,000 people nationwide in 1955, according to the report by
the national nonprofit Treatment Advocacy Center.
"The results of this report are dire and the failure to provide
care for the most seriously mentally ill individuals is
disgraceful," said Dr. E. Fuller Torrey, president of the
Arlington, Va.-based center that advocates for treatment of the
mentally ill.
"Our communities are paying a high price for our failure to
treat those with severe and persistent mental illness, and those
not receiving treatment are suffering severely."
Researchers with the center are urging at least 12,200 beds be
added across California, nearly double the 6,285 beds that were
counted in 2005.
In Los Angeles County, health officials said 140 beds are spread
throughout the public hospital system and there are another 222
beds at Metropolitan State Hospital in Norwalk. County officials
also note more beds are available in private hospitals, nursing
homes and group homes.
But the Los Angeles Police Department and the Los Angeles County
Sheriff's Department say they've become a de facto safety net for
mental health services because there is no room at the hospitals.
At the county's Twin Towers jails, 1,000 beds are filled nearly
every night by psychiatric patients -- more than in any mental
institution west of the Mississippi, according to the LAPD.
And of the nearly 20,000 inmates in the county's jail system,
about 60 percent suffer from mental illnesses, according to a
recent report by the Washington, D.C.-based Justice Policy
Institute.
Meanwhile, incidents involving the mentally ill have surfaced on
L.A.'s streets. In one case last year, the mother of a mentally
disturbed 23-year-old who was shot by police after he ran over a
pedestrian said that hours before he was killed, she pleaded with
the LAPD to apprehend her son.
Luis Salinas, who battled mental illness, had been taken to a
mental facility weeks before, where he had been evaluated and
released 48 hours later. Doctors there said he was suffering from a
brief psychotic disorder.
The '5150' patient
Emergency rooms also are scrambling to meet the needs.
"We have acute and chronic demand for what we call the '5150'
patient -- or those who are hospitalized without their consent,"
said Jim Lott, executive vice president of the Southern California
Hospital Association. "These patients are very hard to find beds
for and are clogging up hospital emergency rooms."
Fueling the issue, Gov. Arnold Schwarzenegger signed an overdue
state budget last summer that included slashing $55 million for
housing the homeless mentally ill.
"There has been no word or movement on the issue (of more beds)
from anyone in the state," Lott said.
Medicare rates also affect behavioral health units at private
community hospitals that rely on the government reimbursements.
On Friday, Los Robles Hospital & Medical Center in Thousand Oaks
closed its 16-bed mental health unit for seniors because of
declining reimbursements, according to published reports.
The average cost to hospitals to treat those with severe mental
illness is about $800 a day, Lott said. But for homeless or
Medicare patients, hospitals receive $475 from the state and the
county. Without that money, many of the units have been shuttered,
he said.
The decline in the number of beds for mentally ill patients also
comes amid an overhaul of state mental institutions -- stand-alone
facilities that started closing during the Reagan administration.
"Over the last decade, we have cut many beds from state
hospitals as we've developed more in community settings," said Dr.
Roderick Shaner, medical director for the Los Angeles County
Department of Mental Health.
"The bottom line is we need every kind of service but we can't
use models of a half-century ago."
The solution falls on community hospitals and organizations that
can likely secure federal funding for more beds -- something state
hospitals are unable to do, Shaner said.
"I think that in the longer term, we are developing new
resources ... that will allow us to support the people in the
community," Shaner said. "However, there is a problem with
getting access to emergency psychiatric hospitalization in the
short run."
Jonathan Stanley, deputy executive director for the Treatment
Advocacy Center, said that while attitudes and treatment toward the
mentally ill have improved, the bed shortage means hospitals are
slashing the amount of time for treatment.
"I think the average stay in a psychiatric hospital now is
seven days to help them get stabilized with their meds," Stanley
said. "But the problem is they are not staying long enough and
they are still systematic when they leave. They end up coming back
or going to jail."
Bucking the trend
Some San Fernando Valley facilities are trying to buck the
trend, especially for the elderly with mental health issues,
including depression and early signs of dementia.
Sherman Oaks Hospital is hoping to add 19 beds for those 55
years and older with mental health issues.
The hospital had shut down its behavioral health unit -- which
served those who were involuntarily admitted -- in 2006 because it
never reached capacity.
The new facility is for voluntary patients and aimed at treating
seniors with a full spectrum of mental illness.
Experts said the need could be great, as 79 million baby boomers
are aging and some might have received inconsistent treatment in
their youth, resulting in what could be a wave of mental health
needs.
"We're looking at the backlash of the Reagan movement. These
people were in their 20s and 30s and are now in their geriatric
situations," said Tricia Devon, director of psychiatric services
at Sherman Oaks Hospital. "We need to find a different way to
treat patients. There's too many people in the streets."
The Jewish Home for the Aging in Reseda also has opened a 10-bed
behavioral unit.
"We saw there was a need for this, with our own residents here
at the home," said Gay Howard, who heads the unit. "A lot of
these patients were identified for behavioral therapy, but they
didn't want to leave because this is their home."
The average amount of stay in the new unit is about 10 days,
Howard said, and treatment includes activities and therapy.
"We are dealing with people who come from an era where they
didn't talk about their problems," she said. As a result "they
don't receive the proper diagnosis and no one then knows they are
depressed.
"We want to tell them it's OK to ask for help."
c.2008 Los Angeles Daily News