Wednesday, March 31, 2021

Psychiatric emergencies

This City Journal article says that
The number of patients seeking emergency psychiatric care has risen rapidly in the past few years, and the hospital frequently operates beyond its regular capacity, issuing “single bed certifications” and allowing people to rest on cots in the hallways and mats on the floor. The severity of the cases has increased, too. Beall estimates that, as recently as a few years ago, only 20 percent of patients needed inpatient treatment; now that figure is between 50 percent and 60 percent.

I'll trust his numbers for now. I don't think the US population has risen quite that much.

What drives this? Drug use? Vulnerable people who lost their family/network support and wound up on the street and got way worse? Were they always here and somehow found ways of managing until now? Fewer facilities increases the burden on the remaining ones? Minor changes in definition plus low statistics? Something in the water? No, I'm not being flip.

The local school has seen a very significant rise in the number of children needing extra attention, but I've no idea if that's related.


Assistant Village Idiot said...

Most of your readers will know that acute psychiatric care was my career for forty years, so this opinion is based on reading, observation, and continuous consultation. I also think I am more objective than most people in my field. Of course, I would think that, wouldn't I?

Drug use is one, yes.

What those numbers fail to pick up is the number of days of those admissions. The trend to shorter but more frequent admissions has been going on for many decades now. There was a time when if you got sent to the state hospital, many people figured they would not see you back in town again ever, certainly not for the next few months. Overnight admissions are still not that common, but two nights and out was the goal for one unit I was on (we were able to screen for likely shorter admissions, at least some of the time). 3-8 days used to be our given estimate in the 90s, down to 2-5 by the time I left.

That ties in with the quick recovery times for drug use complications, and the brief suicidal experiences of the personality disordered. In general, we would rather see someone six times over the course of a year for a few days than a single longer admission of two months or more that used to be expected. But even for purer Axis I admissions, restabilising on medications can be quick. What extends admissions is often not the patient's condition, but the weariness of the support systems who have been keeping them afloat for weeks or even years. They usually feel the patient is not much different than when they came in. They wanted more fixing to happen.

All this should give the lie to the idea that it is economic conditions, because poverty and homelessness were both way down until covid. It won't stop most of the mental health field from continuing to believe it anyway. Perhaps I should post on why that is.

Finally, I think there has been a steady increase in readiness for people to seek help and the expectation that someone can fix it for them, combined with a decreased risk tolerance for some community agencies who fear being sued.

james said...

Is there a difference in the patients' support systems? Over 40 years, they might have gotten smaller, or changed to include more friends and fewer family (or v.v.)...

james said...

Thank you for your observations, btw. These sorts of emergencies are very far from my "wheelhouse."

Assistant Village Idiot said...

The support systems are less family - though Mom is still the mainstay more often than anyone else - and more government agencies. Friends are more mixed. As the country has been more mobile there are fewer long-time friends for all of us. People do meet friends at shelters, mental health centers, and rehabs.