The controversy over treatment of patients at state mental hospitals
In today’s turbulent economic times, funding for state mental hospitals and county mental health services is dwindling, and the chronically mentally ill and the health care providers who serve them face many challenges as they compete for ever-shrinking resources. With so few beds in state mental hospitals available, often only the patients deemed dangerous to society are getting institutional treatment. The rest slip through the cracks. How can health care administrators at these hospitals manage their limited resources while still serving this vulnerable patient population?
“Funding for mental health is always the first thing in the state budget to get cut,” says a psychiatric nurse and University of Phoenix faculty member.“Outpatient programs for substance abuse and mental health treatment are available for patients with health insurance benefits, but free programs are scarce and have long waiting lists.”
State-funded mental health programs also tend to focus on those patients whose illnesses lead to criminal behavior. “The types of patients in state mental hospitals are often sexual perpetrators or sex offenders with criminal backgrounds, both adolescents and adults,” says the faculty member. “The types of patients in the county outpatient systems are those with chronic mental health disorders such as paranoid schizophrenia, some of whom are unstable, untreated, undiagnosed and unwilling to voluntarily consent to treatment for various reasons.”
Not enough care resources to go around
Other experts agree with this assessment. “There is definitely a shortage of state hospital beds relative to the overwhelming number of mental health patients who have been adjudicated (i.e., ordered by the courts) for those beds,” says Park S. Balevre, RN, MSN, a retired psychiatric nurse as well as an area chair for Nursing at University of Phoenix in Jacksonville, Fla. “These patients can linger in acute care facilities for up to a year before receiving a state bed. And the acute care units primarily serve as custodial facilities, without substantive one-on-one interventional therapy. Once the patient is admitted to the state hospital for a short stay, the patient is released and the whole revolving door begins to swing around again.”
Another obstacle these patients face is the survival of the state hospitals and outpatient programs. “Hospitals are beginning to lose millions of dollars per year,” says the unnamed faculty member. “Even with the tightest budgets and scrutinizing all expenses, there is very little they can do to make up that amount. Layoffs often have to occur, programs sometimes have to be cut. Selling off of hospitals may have to occur.”
A shift toward privatization?
How can state mental health hospitals and outpatient programs continue to function with so many funding challenges? There are many possible solutions, but the future remains unclear. “One growing trend is toward privatization,” says Balevre. “While this may improve pay-for-performance, the concern many have here in Florida is that it could have the opposite effect.”
The faculty member we spoke with is skeptical of privatization efforts based on her experiences in Arizona. “Arizona has a for-profit company managing the state mental health benefits for the chronically mentally ill,” she says. “This is not a good state to be living in if you have a chronic mental illness such as schizophrenia.”
However, she says there are still some promising alternatives. “Looking for new revenue streams is a possibility. Forming networks of providers that collaborate together to provide services over the continuum of care may be a good solution so prices can be better negotiated for clients.”