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Hospitals see ‘ridiculous’ shortage of psychiatric beds, long wait times during pandemic.

The shortage of beds and resources for psychiatric patients is accelerating threefold during the pandemic, leading to “ridiculous” bottlenecks in hospitals and long admittance wait times.

“Within the last week, we’ve had up to 39 patients in the emergency department looking for psychiatric services, and Monday of this week, we had 11 people who had been there at least 100 hours,” said Dr. Curtis Wittmann, a psychiatrist at Mass General Hospital. “It’s completely ridiculous, it should never happen.”

COVID-induced job losses, fear and isolation have all taken a toll, as well as delays in seeking care, leading to a regular bottleneck of over 500 patients per day in the state awaiting specialized psychiatric care, according to a survey by the Massachusetts Health & Hospital Association conducted this summer.

Even though hospitals have seen a drop in COVID cases in emergency rooms, emergency rooms are overcrowded with patients who ended up there because they put off preventive or minor care earlier in the pandemic, further slowing down psychiatric patients’ care.

Patients are also sicker — a new impact of the pandemic — including “patients with severe psychosis, patients with severe depression or other mood symptoms or anxiety that lead to suicidal thoughts, patients coming in after suicide attempts,” said Dr. Sejal Shah, medical psychiatry chief at Brigham and Women’s Hospital.

These patients can’t be treated in an outpatient setting. “They’re just too sick,” Shah said.

Hospitals are also experiencing a workforce shortage, which leaves badly needed beds empty. COVID burnout could be a factor, said Dr. Susan Szulewski, McLean Hospital’s associate chief medical officer. Because patients are sicker, many need round-the-clock, one-to-one supervision as they await specialized care.

“They are definitely not getting the level of care that they would on an inpatient psychiatric unit,” Shah said of these waiting patients. “They’re not going to group therapy, they’re not getting individual therapy, they are being seen by psychiatrists each day, but not for as long a period of time.”

The crisis is even worse for children where, at Tufts Children’s Hospital, they have had to wait an average of almost a week and a maximum of over six weeks for an inpatient psychiatric bed.

To combat this, the hospital has remodeled generic inpatient units to be safe for psychiatric patients by, for example, making modifications to toilets and shower heads. Although the hospital ensures children have access to a suite of therapists, social workers, music therapists and a service dog, “the real solution is expanding these facilities that are actually expert at treating patients like this,” said Terry Hudson-Jinks, chief nursing officer and senior vice president of patient care services at Tufts Medical Center.

Boston-area hospitals have worked around these issues by increasing the number of beds, as McLean did with 92 additions in the past year and MGH with 20, coordinating daily psychiatric calls across units to place patients faster and ensure good care, and using telehealth in a pinch. The Baker administration has also provided funds for staffing and additional psychiatric beds.

In the long run, Monica Luke, who serves on the board of the National Association of Mental Illness Massachusetts, said a national behavioral health crisis system like the 988 system approved by Congress last year would help.

But for now, hospitals have to make do.

“People routinely stay late, go above and beyond to try to come up with something to help somebody. You see a lot of amazing things when you do this work,” Wittmann of MGH said. “But it’s really hard to watch people suffer and be stuck for so long.”

https://www.bostonherald.com/2021/08/26/hospitals-see-ridiculous-shortage-of-psychiatric-beds-long-wait-times-during-pandemic/