Psychiatric beds needed to treat people
The Centers for Disease Control and Prevention recently released their annual mortality report that showed, once again, an increase over the prior year in the number of suicides by Americans.
The data shows that132 Americans die by suicide, half by firearms, every single day. That is a 35% increase in the age-adjusted suicide rate since 1999, the highest since World War II. Suicide is the 10th leading cause of death in the U.S., the second leading cause among people under the age of 35. The suicide rate in the U.S. exceeds all modern industrialized countries, twice that of the United Kingdom and 25% more than Canada and Australia.
In addition to the 48,000 lives lost to suicide each year, millions more think about it. In 2017, the CDC reported that 10.6 million Americans seriously thought about suicide, while 1.4 million made a suicide attempt. The CDC also reported that there has been a 42% increase in emergency department visits for suicidal ideation since 2001.
We could be doing more as a country to help people with thoughts of taking their lives — and those who actually attempt to do so. But a shortage in psychiatric beds is proving a huge hurdle in getting people treatment.
Suicide is a mortality of depression, a serious psychiatric illness. Interrupting a suicidal impulse, getting in between a person who is suicidal and the method of hurting themselves, such as guns, is lifesaving. However, the capacity to take care of psychiatric emergencies in the U.S. has decreased dramatically. Since 1999, there has been a 35% decrease in the number of psychiatric beds in the U.S. We now have 20 beds per 100,000 population with only four countries in the developed world that have fewer beds. The worldwide average is 71 beds per 100,000 population.
In the past few decades, there has been a simultaneous rise in suicide rates as the availability of psychiatric beds have declined. Questions about correlation versus causation aside, the mirror-image trend is a portrait of the public health crisis in this country. How many suicide deaths could be averted if we had more psychiatric beds?
Boarding of psychiatric patients in emergency departments is commonplace, in large part due to waiting for an open psychiatric bed. The low availability of psychiatric beds has contributed to the trend for very short stays, averaging four or five days. Patients are discharged quicker but sicker contributing to the high risk of suicide after discharge from a psychiatric inpatient stay. We need more psychiatric beds to have more time to stabilize patients in crisis and to come up with a diagnosis and treatment plan.
Vital to reversing this suicide mortality trend is to be able to intervene with an individual at the right moment, which includes a greater capacity of psychiatric beds to take care of psychiatric emergencies and promote stabilization and recovery. Red flag laws that allow the confiscation of guns when someone is depressed and expresses a wish to self-harm will also help this epidemic.
Nearly half of the people who die by suicide have seen a medical professional within the six-months prior to their death, most often a general physician. All physicians need the proper skills to assess depression and the possibility of suicide and to intervene and hospitalize, if necessary. Suicide deaths can be prevented. Only 7% of individuals who had a previous suicidal attempt will die by suicide.
Goals of inpatient care include crisis stabilization and safety, comprehensive diagnostic formulation, biological and psychological assessment, respite, family engagement, and comprehensive discharge planning. But if there are no beds available, we will continue to see the 30-year mirror image trends: an increase in suicide as the psychiatric beds disappear.