Private Psych Units Close and Open

As the number of state hospital inpatient psychiatric beds continue to decline across in the country in an now well known ill advised and foolish move, private psychiatric units are also both closing and opening as the “market” struggles to either stay profitable in the face of continually declining incomes and reimbursements and higher costs, or, to take a commendable stand in seeing their “mission” as providing a heartfelt mission to serve their local communities in need of inpatient psychiatric beds. This is especially true in non “big U”, big university medical center cities, ordinary cities where the private sector is now beginning to inherit the burden of psychiatric care crisis around the country. Almost always these services (no surprise) are “loss leaders,” like sales a groceries stories that are money loser but get grocery shoppers in the door to buy other items that are profitable. But in inpatient mental health there are no heart bypass surgeries or such that are such gross moneymakers in the rest of American medicine.

In a recent article in the “Psychiatric Advisors,” “Cuts in Mental Health Services Increase psychiatric emergencies,” [Note if this link does not work, simply search on Google the title of the article] the emphasis is on the well known phenomenon that without available psychiatric beds, MH patients go to and clog the ERs. This article originally published in the Annals of Emergency Medicine, showed that emergency psychiatric dept. visits lengths alone increased by 55%! The hospital studied in California was actually surprisingly a university medical center with an inpatient psychiatry department that had lost beds and funding, the University of California Davis School of Medicine.

Just this week, Monday Dec. 14, 2015 in the St. Louis Post-Dispatch, a Pulitzer Prize winning paper, an article entitled: “BJC decision to close psychiatric unit hits St. Francois County,” which is just 79 miles south of St. Louis. The article goes on to document the larger healthcare corporation of “BJC Healthcare” which closes a smaller area hospital it bought, the former Mineral Area Regional Medical Center i Farmington MO. the 10 ed adult behavioral-psychiatric unit was closed in the 135 bed hospital as it was not profitable. Another hospital in Farmington also owned by BJC had”some services” (unspecified) to another hospital by BJC. Smells of a monopoly but the free market forces so often touted by national figures don’t work so neatly in smaller areas that cannot support in today’s cutthroat economic climate, multiple hospitals in smaller MSA’s (metropolitan statistical areas). As the article tellingly says, “But the psychiatric won’t make the move–and that creates a gap that other nearby providers cant provide, i.e., miles away in the Big City of St. Louis because of distance for families and other factors.

The article goes on to sadly report that the local state psychiatric hospital in Farmington, MO, Southeast Missouri Mental Health Center, has itself closed 54 psychiatric beds, obviously limiting its ability to pick up the slack. One of the things wrong with the private-public interface in mental health care is that often situations like these arise because there is NO coordination or advance planning between the two worlds, so what is taken away in one arena is not replaced in the other and patients are left in the lurch, in ERs, in jails, on the streets or being ill at home with no recourse.

And private corporate medical entities many times feel no dedicated “mission” to their communities. I will cite again, two of the private hospitals I know of from actual experience with and within them, that do hold to the now possibly outdated concept of “mission to the community,” as they keep unprofitable psychiatric units open that are almost always and more egalitarian mixture of private and public patients, I speak of Margaret R. Pardee Hospital in Hendersonville NC, (western NC) and Durham Regional Hospital in Durham NC. The rest of the revenue of these hospitals support the losses of the psych units and they do so for laudable reasons. In many areas of the country the community hospitals simply cannot afford to do so any longer, and the corporate entities now dominating American hospital medicine often choose not to.

I do not know the actual percentage divide on whether we are catching up through the creation of new private psychiatric beds as seems to be happening in a few places in the country, undertaken usually by strong private hospitals, or whether we are losing ground. That will take some more future statistic digging. But I suspect that we are losing ground and I am fairly confident of that speculation.

In my next post I hope to show with some data research done in region of the country that at least one state, among many others is now finding out it needs MORE state psychiatric hospitals not fewer, a fact and trend that mental health providers and provider organizations saw as the neglected and ignored truth decades ago.







Author: Frank

I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.

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