An­ti­quated laws con­trib­ute to short­age of be­hav­ioral health beds

Modern Healthcare - - Comment -

Thank you for the ar­ti­cle “Emer­gency rooms fill up with psych pa­tients—and then they wait” (ModernHealth­, 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.

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