Trump eyes mental institutions as answer to gun violence

Kevin Freking

Associated Press
Originally published August 30, 2019

Here is an excerpt:

But Trump’s support for new “mental institutions” is drawing pushback from many in the mental health profession who say that approach would do little to reduce mass shootings in the United States and incorrectly associates mental illness with violence.

Paul Gionfriddo, president and chief executive of the advocacy group Mental Health America, said Trump is pursuing a 19th century solution to a 21st century problem.

“Anybody with any sense of history understands they were a complete failure. They were money down the drain,” said Gionfriddo.

The number of state hospital beds that serve the nation’s most seriously ill patients has fallen from more than 550,000 in the 1950s to fewer than 38,000 in the first half of 2016, according to a survey from the Treatment Advocacy Center, which seeks policies to overcome barriers to treatment.

John Snook, the group’s executive director, said Trump’s language “hasn’t been helpful to the broader conversation.” But he said the president has hit on an important problem — a shortage of beds for the serious mentally ill.

“There are headlines every day in almost every newspaper talking about the consequences of not having enough hospital beds, huge numbers of people in jails, homelessness and ridiculously high treatment costs because we’re trying to help people in crisis care,” Snook said.

The info is here.

Telehealth use jumps at inpatient settings

Shannon Muchmore
healthcaredive.com
Originally posted August 6, 2019

Here is an excerpt:

Hospital-owned outpatient facilities were more likely to use telehealth than those not owned by hospitals. Outpatient facilities tended to use patient portals or apps more than inpatient respondents but also had broad adoption of hub and spoke models.

Still, providers in a variety of settings keeping a close watch on possibilities and wanting to stay at the forefront of the technology, said Kate Shamsuddin, SVP of strategy at Definitive.

The results "show how telehealth continues to be one of the core linchpins" for providers, she told Healthcare Dive.

The inpatient report found telehealth use jumped from 54% when the survey was first taken in 2014 to 85% in 2019. The most common model is hub and spoke (65%), followed by patient portals or apps (40%), concierge services (29%) and clinical- and consumer-grade remote patient monitoring.

The tech most often used in that setting was two-way video between physician and patient. That is also the category respondents said they were most likely to invest in for the future.​ Shamsuddin said hospitals and health systems tend to have a broader mixture in the types of technologies they use due to their larger budgets and scale.

The info is here.

Mental hospital accused of holding Texas patients against their will has filed for bankruptcy

Sarah Sarder
www.dallasnews.com
Originally posted February 12, 2019

A North Texas mental health institution with hospitals in Garland, Fort Worth and Arlington has filed for bankruptcy months after being indicted in a criminal case over illegally detaining patients.

Sundance Behavioral Healthcare System filed for Chapter 11 bankruptcy Thursday. The system faces 20 charges of violating state mental health codes after being indicted in November and December.

In December, Sundance stopped accepting patients at its hospitals and “voluntarily brought its patient count to zero,” its attorneys said.

The corporation announced that it had surrendered its license on Dec. 21 to the state. Attorneys said the hospital could not financially sustain its services in light of the court proceedings.

The info is here.

Feds probing psychiatric hospitals for locking in patients to boost profits

Beth Mole
Ars Technica
Originally published May 24, 2017

At least three US federal agencies are now investigating Universal Health Services over allegations that its psychiatric hospitals keep patients longer than needed in order to milk insurance companies, Buzzfeed News reports.

According to several sources, the UHS' chain of psychiatric facilities—the largest in the country—will delay patients' discharge dates until the day insurance coverage runs out, regardless of the need of the patient. Because the hospitals are reimbursed per day, the practice extracts the maximum amount of money from insurance companies. It also can be devastating to patients, who are needlessly kept from returning to their jobs and families. To cover up the scheme, medical notes are sometimes altered and doctors come up with excuses, such as medication changes, sources allege. Employees say they repeatedly hear the phrase: “don’t leave days on the table.”

The Department of Health and Human Services has been investigating UHS for several years, as Buzzfeed has previously reported. UHS, a $12 billion company, gets a third of its revenue from government insurance providers. In 2013, HHS issued subpoenas to 10 UHS psychiatric hospitals.

But now it seems the Department of Defense and the FBI have also gotten involved.

The article is here.

Jail cells await mentally ill in Rapid City

Mike Anderson
Rapid City Journal
Originally published February 7, 2017

Mentally ill people in Rapid City who have committed no crimes will probably end up in jail because of a major policy change recently announced by Rapid City Regional Hospital.

The hospital is no longer taking in certain types of mentally ill patients and will instead contact the Pennington County Sheriff’s Office to take them into custody.

The move has prompted criticism from local law enforcement officials, who say the decision was made suddenly and without their input.

“In my view, this is the biggest step backward our community has experienced in terms of health care for mental health patients,” said Rapid City police Chief Karl Jegeris. “And though it’s legally permissible by statute to put someone in an incarceration setting, it doesn’t mean that it’s the right thing to do.”

This is the second major policy change to come out of Regional in recent days that places limits on the type of mental health care the hospital will provide.

The article is here.

Increase in US Suicide Rates and the Critical Decline in Psychiatric Beds

Tarun Bastiampillai, Steven S. Sharfstein, & Stephen Allison
JAMA. Published online November 3, 2016

The closure of most US public mental hospital beds and the reduction in acute general psychiatric beds over recent decades have led to a crisis, as overall inpatient capacity has not kept pace with the needs of patients with psychiatric disorders. Currently, state-funded psychiatric beds are almost entirely forensic (ie, allocated to people within the criminal justice system who have been charged or convicted). Very limited access to nonforensic psychiatric inpatient care is contributing to the risks of violence, incarceration, homelessness, premature mortality, and suicide among patients with psychiatric disorders. In particular, a safe minimum number of psychiatric beds is required to respond to suicide risk given the well-established and unchanging prevalence of mental illness, relapse rates, treatment resistance, nonadherence with treatment, and presentations after acute social crisis. Very limited access to inpatient care is likely a contributing factor for the increasing US suicide rate. In 2014, suicide was the second-leading cause of death for people aged between 10 and 34 years and the tenth-leading cause of death for all age groups, with firearm trauma being the leading method.

Currently, the United States has a relatively low 22 psychiatric beds per 100 000 population compared with the Organisation for Economic Cooperation and Development (OECD) average of 71 beds per 100 000 population. Only 4 of the 35 OECD countries (Italy, Chile, Turkey, and Mexico) have fewer psychiatric beds per 100 000 population than the United States. Although European health systems are very different from the US health system, they provide a useful comparison. For instance, Germany, Switzerland, and France have 127, 91, and 87 psychiatric beds per 100 000 population, respectively.

The article is here.

Psychiatric patients wait the longest in emergency rooms

By Amy Ellis Nutt
The Washington Post
Originally published October 18, 2016

Here is an excerpt:

Many studies over the past decade have shown that ER overcrowding results in higher mortality rates of ER patients, higher costs and higher stress levels for medical professionals.

That overcrowding won’t end anytime soon, Parker said, unless access to outpatient treatment centers expands. But in the latest survey, more than half of the ER physicians said mental health resources in their communities had declined in the past year.

The paradox at the heart of the problem is almost beyond comprehension, in Lippert’s view.

“Nowhere else in medicine,” she said, “do we have our most severely ill patients staying the longest.”

The article is here.

Why do suicidal patients wait hours for a hospital bed?

By Corinne Segal
PBS News Hour
September 18, 2016

Here is an excerpt:

Health workers and lawmakers are working to accommodate patients like Durant as America endures a suicide surge, with suicide deaths rising from 29,000 people to 43,000 people between 1999 and 2014. Some have tried to increase the number of psychiatric beds available to suicidal patients, a disappearing resource in recent years that forces patients like Durant to wait longs hours for care. Meanwhile, others are assessing whether the hospital is even the right place to start considering treatment.

In recent decades, “We closed thousands of beds and we didn’t cure mental health,” David Mattodeo, Executive Director of the Massachusetts Association of Behavioral Health Systems, said. “The problem didn’t go away.”

The article is here.

Nation’s psychiatric bed count falls to record low

By Lateshia Beachum
The Washington Post
Originally published July 1, 2016

The number of psychiatric beds in state hospitals has dropped to a historic low, and nearly half of the beds that are available are filled with patients from the criminal justice system.

Both statistics, reported in a new national study, reflect the sweeping changes that have taken place in the half-century since the United States began deinstitutionalizing mental illness in favor of outpatient treatment. But the promise of that shift was never fulfilled, and experts and advocates say the result is seen even today in the increasing ranks of homeless and incarcerated Americans suffering from serious mental conditions.

The article is here.

E.R. Costs for Mentally Ill Soar, and Hospitals Seek Better Way

By Julie Creswell
The New York Times
Originally published December 25, 2013

Here is an excerpt:

Today, North Carolina has only eight beds in state psychiatric hospitals per 100,000 people, the lowest ratio in the country.(North Carolina, like other states, has added beds in local community facilities but, even then, its total beds are down a quarter since 2001.)

Uninsured patients rarely receive individual therapy, only group sessions. And it can take up to three months to see a psychiatrist.

“Now, we are seeing some of the most acute, the most aggressive and the most chronic mental health patients, and we’re holding them longer,” said Janice Frohman, the director of WakeMed’s emergency department.

The effects of the upheaval in care of the mentally ill is playing out vividly at WakeMed. A private, nonprofit organization with 884 beds, WakeMed is struggling to find a way to meet the needs of increasing numbers of mentally ill patients while also controlling costs.

The entire article is here.

The Woman Who Ate Cutlery

By CHRISTINE MONTROSS
The New York Times - Opinion
Published: August 3, 2013

Here are some excerpts:

The costs of M’s repeated hospitalizations are staggering. Her ingestions and insertions incur the already high costs of hospital admission and the medical procedures and surgeries she requires. In addition, once M is hospitalized as a psychiatric patient, a staff member must stay with her at all times to make sure she doesn’t ingest utensils from her meal trays, insert tools from group craft activities into her body or drink Purell from the dispensers on the unit walls.

(cut)

In one of the ironies in a country with health care discrepancies, a single hospital admission for M — paid for by the taxpayer-financed state medical-assistance program — costs more than a year of private outpatient care would.

The entire article is here.

Thanks to Tom Fink for the story.

The Problem With How We Treat Bipolar Disorder

By Linda Logan
The New York Times
Originally published on April 26, 2013

The last time I saw my old self, I was 27 years old and living in Boston. I was doing well in graduate school, had a tight circle of friends and was a prolific creative writer. Married to my high-school sweetheart, I had just had my first child. Back then, my best times were twirling my baby girl under the gloaming sky on a Florida beach and flopping on the bed with my husband — feet propped against the wall — and talking. The future seemed wide open.

I don’t think there is a particular point at which I can say I became depressed. My illness was insidious, gradual and inexorable. I had a preview of depression in high school, when I spent a couple of years wearing all black, rimming my eyes in kohl and sliding against the walls in the hallways, hoping that no one would notice me. But back then I didn’t think it was a very serious problem.

The hormonal chaos of having three children in five years, the pressure of working on a Ph.D. dissertation and a genetic predisposition for a mood disorder took me to a place of darkness I hadn’t experienced before. Of course, I didn’t recognize that right away. Denial is a gauze; willful denial, an opiate. Everyone seemed in league with my delusion. I was just overwhelmed, my family would say. I should get more help with the kids, put off my Ph.D.

The entire story is here.

Psychiatrists waste 1 million hours getting patients admitted

United Press International
Originally published April 24, 2013

U.S. psychiatrists spend an average 38 minutes telephoning an insurance company getting authorization to admit a patient to the hospital, researchers say.

Lead author Dr. Amy Funkenstein, a child psychiatry fellow at Brown University in Providence, R.I., led the study while she was a psychiatric resident at Cambridge Health Alliance and Harvard Medical School in Boston.

Over a three-month period, the researchers tabulated how long psychiatric patients who were deemed in need of inpatient admission stayed in the emergency department prior to being hospitalized, and the amount of time the ED psychiatrists spent obtaining authorization from the patient's insurer.

Most psychiatric patients required hospitalization because they were suicidal or, in a few cases, homicidal, Funkenstein said.

The entire story is here.

Advocates Seek Mental Health Changes, Including Power to Detain

By BRANDI GRISSOM
The Texas Tribune/The New York Times
Published: February 23, 2013

Here are some excerpts:

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

(cut)

Hospital officials say they face a Catch-22 under current law: if they detain a mentally ill person against his or her will, they face liability because they have no legal authority to do so. If they allow the person to leave and something tragic happens, they risk a lawsuit like the one the Boren family filed.

The entire story is here.

Pa. sends mental health data for gun checks

By Moriah Balingit / Pittsburgh Post-Gazette
Originally published January 19, 2013

After facing legal and technical challenges for more than two years, the Pennsylvania State Police this week began transmitting hundreds of thousands of mental health records to a federal database used to conduct background checks for potential gun buyers.

On Tuesday, 643,167 mental health records were sent to the FBI-run National Instant Check System (NICS), according to the state police. The records represent people who are prohibited from buying guns because of involuntary mental health commitments.

"It's been an objective of ours for close to two years, so I think it's an important accomplishment that these records were able to be uploaded to NICS," said Lt. Col. Scott Snyder, deputy commissioner for the state police. The state police are working to fix a program that will upload the records automatically as they're created.

Strengthening the national database and universal background checks have been pillars of President Barack Obama's gun control agenda. On Wednesday, when he unfurled a massive gun control package, some executive orders were intended to make it easier for states to transmit mental health records to NICS.

Despite the state's achieving that goal, a disagreement between the state police and the Bureau of Alcohol, Tobacco, Firearms and Explosives over interpretation of federal gun law throws into question how the records will be used. At issue is the 302, the shortest and most common type of involuntary mental health commitment.

On Friday, a spokeswoman for the ATF said the bureau was still reviewing whether a 302 should preclude someone under federal law from buying a gun.

The entire story is here.

Building a Space for Calm

By ROGER S. ULRICH
The New York Times
Published: January 11, 2013

Here are some excerprts:

Efforts to reduce violence in psychiatric hospitals have focused on identifying potentially aggressive patients through clinical histories and improving staff training and care procedures. But these approaches, while worthy, are clearly not enough. While definitive numbers are hard to come by, the incidence of violence in care facilities appears to be going up.

Research suggests, however, that there’s an effective solution that has largely been overlooked: designing hospital spaces that can reduce human aggression — to calm emotionally troubled patients through architecture.

Currently, questions about design at psychiatric care facilities are viewed through the prism of security. How many guard and isolation rooms are needed? Where should we put locked doors and alarms? But architecture can — and should — play a much larger role in patient safety and care.

One prominent goal of facility design, for example, should be to reduce stress, which often leads to aggression.

For patients, the stress of mental illness itself can be intensified by the trauma of being confined for weeks in a locked ward. A care facility that’s also noisy, lacks privacy and hinders communication between staff and patients is sure to increase that trauma. Likewise, architectural designs that minimize noise and crowding, enhance patients’ coping and sense of control, and offer calming distractions can reduce trauma.

Thanks to decades of study on the design of apartments, prisons, cardiac intensive care units and offices, environmental psychologists now have a clear understanding of the architectural features that can achieve the latter — and few of these elements, if incorporated into a hospital design from the outset, significantly raise the cost of construction.

Providing day rooms and other shared spaces with movable seating, for example, gives patients the ability to control their personal space and interactions with others. Sound-absorbing surfaces reduce noise (and stress), as do designs that offer more natural light.
Some features, like single-patient bedrooms with private toilets, do increase the building cost — but that is arguably offset by the reduced trauma for patients and hospital workers. Violence, after all, isn’t just a danger to well-being, its effects — from medical care to lawsuits — are frequently expensive, too.

The entire story is here.

Thanks to Gary Schoener for this story.

Examination of the Effectiveness of the Mental Health Environment of Care Checklist in Reducing Suicide on Inpatient Mental Health Units

Archives of General Psychiatry
Bradley V. Watts, MD, MPH; Yinong Young-Xu, ScD, MA, MS; Peter D. Mills, PhD, MS; Joseph M. DeRosier, PE, CSP; Jan Kemp, RN, PhD; Brian Shiner, MD, MPH; William E. Duncan, MD, PhD
Arch Gen Psychiatry. 2012;69(6):588-592. doi:10.1001/archgenpsychiatry.2011.1514

Abstract

Objective  To evaluate the effect of identification and abatement of hazards on inpatient suicides in the Veterans Health Administration (VHA).

Design, Setting, and Patients  The effect of implementation of a checklist (the Mental Health Environment of Care Checklist) and abatement process designed to remove suicide hazards from inpatient mental health units in all VHA hospitals was examined by measuring change in the rate of suicides before and after the intervention.

Intervention  Implementation of the Mental Health Environment of Care Checklist.

Results  Implementation of the Mental Health Environment of Care Checklist was associated with a reduction in the rate of completed inpatient suicide in VHA hospitals nationally.

Conclusions  Use of the Mental Health Environment of Care Checklist was associated with a substantial reduction in the inpatient suicide rate occurring on VHA mental health units. Use of the checklist in non-VHA hospitals may be warranted.

The entire article is free here.

Thanks to Ken Pope for this information.

An article about psychologists using checklists to reduce treatment  failure is here.