Mental Illness Treatment in Meltdown
For the past several decades, America’s psychiatric hospitals have been in a state of emergency. There are too few psych beds for too many bodies. Only extreme cases — like the time a woman bit off her own finger because the voices told her to — get quick care. “This is the sad part of this work. People so psychotic they can’t even get to the hospital without doing something terrible to themselves,” nurse manager Jean Horan told the San Francisco Gate in 2006. Former Bay Area E.R. psychiatrist Dr. Paul Linde described the revolving-door policy in 2018: “You’ve got your chow, you’ve got your shower, you’ve got your medication, you’ve got some sleep, and now it’s time to get out the door.”
Patients are often taken by ambulance to emergency rooms, where they are boarded in general acute hospitals that lack psychiatric care. The hospitals then can’t discharge their patients to psychiatric facilities because, more often than not, there are no beds available. It creates a logjammed system that fails everyone, as movement is stymied in almost every direction except to the streets or to jails and prisons, also known as “the beds that never say no,” said Mark Gale, criminal justice chair of the National Alliance on Mental Illness (NAMI). “These are the choices we are making as a society, because we refuse to fund the completion of our mental health system.”
The U.S. is a minimum of 95,000 beds short of need. It’s now harder to get a bed in New York City’s Bellevue Hospital than it is to land a spot at. Sixty-five percent of the non-urban counties in the United States have no psychiatrists, and nearly half lack psychologists, too. If the situation continues as it is, by 2025, we can expect a national shortage of 15,000 desperately needed psychiatrists as medical students seek higher-paying specialties and 60 percent of our current psychiatrists gray out.
