Late last year, Gus Deeds, son of Virginia state Sen. Creigh Deeds (D), allegedly stabbed his father multiple times before turning a gun on himself and committing suicide. The younger Deeds had a psychiatric exam performed under an emergency custody order the previous day, but was released when an available psychiatric bed could not be located for him within the short four-hour window of the order. But Virginia is not the only state that lacks a comprehensive statewide database of available spots for those in need of psychiatric treatment; a ThinkProgress survey of state behavioral health departments found that at least 23 other states also lack any computerized accounting of where beds are available.
In recent years, the number of available psychiatric beds across the country has dropped significantly — often a casualty of budget cuts and a move toward more focus on community treatment. Between 1970 and 2000, the number of public psychiatric hospital beds dropped from 207 beds per 100,000 people to just 21, according to the federal Agency for Healthcare Research and Quality.
Although this decline has coincided with demonstrably higher suicide rates, it continues nonetheless. A 2012 study by the Treatment Advocacy Center found that between 2005 and 2010, the number of state psychiatric beds dropped from 50,509 to just 43,318 — a 14 percent decrease, bringing it to the lowest level since 1850 — and 4,471 more beds were either eliminated or designated for elimination. With fewer and fewer state beds available, many public and private psychiatric facilities are frequently at or near capacity, making it at times difficult to quickly locate an available bed nearby.
ThinkProgress contacted all 50 states and the District of Columbia to ask about their psychiatric intake processes; all but five responded. The results revealed a wide range of systems and processes in the states. Some states, like Oklahoma, allow people to simply show up at any facility and seek evaluation and admissions to a mental health facility (a spokesman for the Oklahoma Department of Mental Health and Substance Abuse Services described it as a “no wrong door policy”). Other states, such as West Virginia, only allow only for involuntary admissions to its state-run psychiatric hospitals. Some states say they at times have turned patients away or placed them on a waiting list due to lack of available spaces, while others contract with private hospitals to place overflow patients as needed.
In 22 states and the District of Columbia, some sort of computerized tracking database is in place — but even these vary widely. Alabama, Connecticut, Texas, and at least six other states track available beds only in their state hospitals or state-run funded beds. Others, including Massachusetts, track private acute care beds. Nevada’s Hospital Available Beds for Emergencies and Disasters (HAvBED) relies on mandatory reporting daily by every public and private facility in the state. Even states have that have comprehensive databases, however, often must rely on voluntary participation: a spokesman for Maine’s Department of Health and Human Services observed that his state “does have this capacity, but not all hospitals report, so it is not necessarily accurate.”
And even in states with active databases, that is no guarantee of an available bed. Dr. Jeffrey Geller, Director of Public Sector Psychiatry and Professor of Psychiatry at the University of Massachusetts Medical School, told ThinkProgress that in his state, the “central office of the Department of Mental Health knows every day where every available bed is. Assignments are made to those beds through the central office, both for civil patients and for forensic patients.” But “public sector beds are running 95 percent, plus or minus, filled all the time,” he noted, and there are waiting lists for patients needing a bed.
Geller also noted that in many states, the system gets “sequentially backlogged.” As such, “if you have a system where admissions (civil patients) are admitted only from referral hospitals, general hospital psychiatric units or private hospitals, even if the person is accepted, they can’t move until there’s a bed. People in general hospital beds are taking up the rooms that people in general emergency rooms could take if they weren’t there waiting. The psychiatric patients back up not only the public beds but also the general hospital and private beds.” And, he notes, it is often impossible to measure how many people are “turned away,” because availability of space is often a consideration when deciding whether someone’s condition is urgent enough to require hospitalization.
In December, Mary Ann Bergeron, executive director of the Virginia Association of Community Services Boards, told the Associated Press that “a psychiatric bed registry is a very good idea,” but “if people think it is the answer, they are incorrect.” Yet, while far from a perfect solution to the challenges of mental health access in the United States, Virginia Sen. Senator Stephen H. Martin (R) said in the same story that “a thorough and complete and regularly updated bed registry would be a very good thing to have.”
Since 2009, Virginia has been planning to create a Virginia Acute Psychiatric and CSB Bed Registry. Though it was supposed to launch in 2012, staffing and budget cuts prevented that from happening and the site is now expected to go online March 1. A series of mental health reforms proposed by Deeds this year includes a provision that would require Virginia to operate such a database.
Still, with no operative database in place yet, Virginia has a lot of company. States from North Dakota to California said they lack any computerized system to track where beds are and aren’t available.
Spokespeople for the behavioral health departments in Illinois, Kentucky, Montana, and Virginia did not respond to repeated requests for comments.
A spokeswoman for Kentucky’s Department for Behavioral Health, Developmental & Intellectual Disabilities told ThinkProgress that while the state has no statewide tracking database, each hospital tracks its own available beds.Mason Atkins and Mike Rivera contributed to this report.