Antiquated laws contribute to shortage of behavioral health beds

Thank you for the article “Emergency rooms fill up with psych patients—and then they wait” (ModernHealthcare.com, Jan. 28), which highlights several local problems and some potential solutions related to boarding psychiatric patients in Michigan’s hospital emergency departments.

We think it’s equally important to emphasize how some outdated federal policies have led to the shortage of available beds—not only in Michigan, but throughout the U.S.

Consider these findings from a 2017 Agency for Healthcare Research and Quality report: Between 2006 and 2014, the overall number of ED visits increased by nearly 15%. Meanwhile, the number of ED visits for patients with mental health or substance use disorders during that same eight-year period increased by a little more than 44%, or nearly three times higher than the rate for overall ED visits.

Two antiquated policies from the Johnson administration have contributed to this growing crisis. The first is the institutions for mental diseases, or IMD, exclusion, which prohibits Medicaid beneficiaries between the ages of 21 and 64 from accessing treatment in free-standing behavioral healthcare treatment facilities with more than 16 beds. The IMD exclusion has prevented patients who need it from receiving inpatient behavioral healthcare treatment and, consequently, compounded the ED boarding crisis in the nation’s hospitals.

Similarly, Medicare’s 190-day lifetime limit on inpatient treatment at free-standing behavioral healthcare facilities has also worsened ED boarding. This restriction is the only such limit on inpatient treatment in the Medicare program, which discriminates against behavioral healthcare patients.

The most effective—and quickest— way to reduce ED boarding nationally is to remove these discriminatory laws that violate patients’ rights and mental health and substance use disorder parity.

Mark Covall President and CEO National Association for Behavioral Healthcare Washington, D.C.

Bob Nykamp Vice president and COO Pine Rest Christian Mental Health Services Grand Rapids, Mich.