'It's a pretty dire situation': NC needs more hospital beds for mental health patients

Samantha Kummerer Image
Wednesday, August 24, 2022
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The need for more behavioral health-specific hospital beds is evident inside practically every emergency department in the state.

RALEIGH, N.C. (WTVD) -- The need for more behavioral health-specific hospital beds is evident inside practically every emergency department in the state.

"There's nothing more frustrating as a health care provider, when someone needs something that you can't give them," described Dr. Micah Krempasky, a chief medical officer at WakeMed.

WakeMed predicted it will complete around 13,700 mental health consultations in its emergency departments this year; 4,300 more than in 2019.

While demand grows, the number of resources to support it is not.

Across the state, patients are waiting an average of 12 days to get into a state psychiatric hospital after an emergency department refers them. It is double the wait time from three years ago and nearly four times longer than in 2013.

"That's unacceptable in other fields of medicine," Krempasky said. "If someone came in with cardiac needs, and we said wait 2,3,4 days, that wouldn't be okay. But that's what has become our reality with mental health care. So, we need care, but it's just not available."

She said in-patient mental health care looks a lot different than the care a general hospital can provide. Some of the unique services include group therapy, community support and 'healing environments.'

Peg Morrison, the assistant executive director of North Carolina's National Alliance on Mental Health (NAMI) called the wait time 'unfathomable.'

"I mean imagine how anyone would feel in an ER not getting care and not able to leave. That would make anyone's mental health worse. Now if I imagine myself on the worst day of my life when I'm suffering so deeply that I'm wanting to hurt myself, it's unfathomable and we can do better," Morrison said.

The wait can be influenced by the level of care patients need as well as their insurance. A big reason impacting wait time is a lack of space at facilities. The state has been cutting psych beds for the last two decades. Dr. Marvin Swartz a psychiatrist and professor at Duke University, said North Carolina lost around 900 state psych beds since 2000.

"By design, we reduced the state hospital beds in half, starting in 2000 to 2011. We also lost, because it was unprofitable, general psych beds. We lost about 500 of those. So, we have a real shortage," Swartz said. "Even if we grew the workforce, even if we grew crisis centers and alternative capacity, we'd still be short."

North Carolina has around 22 psych beds for every 100,000 residents, this falls short of the recommended 50 beds. Back in 1955, the state had 340 psych beds for every 100,000 residents.

WakeMed estimated the state will fall further behind as population and demand continue to increase. Without additional resources, the state will have a deficit of 500 beds by 2030.

"We do we have population growth. That's phenomenal in this area...We're starting with a shortage of mental health professionals and a shortage of beds, and I want to be clear, we are working to get people to the open beds, and the state is doing a good job developing a mechanism for that, so that they can see in real-time where the beds will be available. But yes, I'm very concerned about population growth," Morrison said.

She said the state is working on developing a dashboard where hospitals can easily see where open psych beds are available across the state.

The ABC11 I-Team found only around 38 North Carolina counties report having psych beds within their general hospitals. This results in patients having to travel hours for care or just choosing not to seek help at all.

"We lose people all the time to care because they're not willing to wait the amount of time that it takes to get into the care they so desperately need," Krempasky said.

Earlier this week, WakeMed put in motion a plan to partially close the gap. On Monday, the hospital system submitted a proposal for a new mental health hospital in Wake County. If approved, the facility would add 150 psych beds by around the year 2027.

"I think it's badly needed, and it was a really welcome bit of news to say that they're stepping up and wanting to do this," Swartz said.

However, he and others said the number of beds is just one part of the issue. Staff to serve those patients and affordability for patients are other top barriers.

"We also need more accessible services before people get into a crisis. So yeah, I would say that the situation is dire and that we've been at an emergency level for some time. COVID has just exacerbated the already broken system," said Nicholle Karim, the senior director of policy for the North Carolina Healthcare Association (NCHA).

Last summer, NCHA, and other organizations sent a letter to state leaders alerting them of the behavioral health emergency underway and urging more resources to be dedicated to correcting the situation. Karim said they never received a response.

"Until our state leaders come up with a plan and fund this adequately, I think we're going to continue to be in the situation that we're in right now, which is people boarding in EDS, needing care, wanting care and us continuing to be bogged down with not enough resources," she said.

Experts also point to the need for Medicaid expansion to help more patients be able to afford the care they do need.

"About a third of people in North Carolina with behavioral health conditions have no insurance," Swartz said. "Medicaid expansion and full implementation of Obamacare would get that from a third of all people with behavioral health conditions how we get it down to 15%."

Experts also point to systematic issues like underfunding mental health and stigma as other factors behind the current lack of resources.

"Hospitals want to be part of that solution. Hospitals are building capacity. They're trying to meet the need, and we can't do it in a silo. We want to be part of the solution here and the solution is going to be more than just hospitals. It's going to have to be all parts of the system working together to make the behavioral health care system accessible for everyone who needs it," Karim said.