Private Inpatient Mental Health Facilities - Heather Vince, BSN, RN, prepares one of the beds in the newly expanded inpatient psychiatry unit as Main Line Health opened a new behavioral health unit at Bryn Mawr Hospital. More JESSICA GRIFFIN / Staff Photographer
On Tuesday Main Line Health opened a new behavioral health unit at Bryn Mawr Hospital that has been in the works for years.
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The $35 million unit boasts private rooms with lush murals; noise-absorbing floors and ambient music to help patients with sensory issues; a gym and spacious areas for yoga and meditation classes; and special beds for the care of patients with serious health problems. Fundraising began in 2018.
Design For Behavioral Health — Kmd Architects
The unit will house double the hospital's behavioral health beds, and officials there hope it will relieve some of the pressure on the long-overstretched mental health system. But they have no illusions that this will solve the problem; it will add just 20 beds to the hospital's previous behavioral health capacity.
"Our new unit is filling up on day one," said Main Line CEO Jack Lynch. "But we are proud to have invested in increasing capacity."
The demand for beds for behavioral health patients across the state is even greater than before March 2020. The shortage is difficult to quantify precisely because not all inpatient beds are suitable for all patients, said Jennifer Jordan, the hospital's vice president. Regulatory advocacy for the Pennsylvania Hospital and Health System Association.
For example, a patient with a high-level medical problem may not be sent to a traditional psychiatric facility that cannot address these needs; and a young, physically healthy patient would be a poor person in a psychiatric nursing home that cares for the elderly with many problems.
Mental Health Inpatient Treatment And Support
However, surveys and national studies suggest that the already overstretched system has been stretched to breaking point during the epidemic. An October 2021 survey by the National Council on Mental Health, a group representing thousands of behavioral health and substance abuse facilities across the country, found that 78% of approximately 260 respondents experienced increased demand for services in the last three months. Three out of five say patient waiting lists have increased in the previous three months.
The demand - and the pressure on suppliers - is caused by a number of factors, experts say.
Due to the emotional and financial strain of life during the epidemic, more people are seeking mental health care. Medicaid reimbursements for behavioral health care are historically relatively low—which means health care providers may not be incentivized to add new beds. And even when a health facility decides to add behavioral health beds, the process can take years to raise funds, hire staff and meet regulatory requirements.
"We simply don't have the infrastructure to meet all the needs of people who are now burdened with mental health disorders," said psychiatrist David Greenspan, chief of psychiatry at the Einstein Health Network.
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Hospitals like Greenspan's, which has a behavioral health unit that can accommodate 47 patients at a time, have emergency rooms and crisis centers full of patients who can't immediately access inpatient behavioral health treatment because there are only beds available for them.
According to hospital officials, the problem is twofold. When some patients in the psychiatric ward receive treatment and are ready to transfer to a less intensive inpatient ward or even to an outpatient clinic, they can be stuck in the ward, waiting days or even months for a more suitable place.
According to experts, many treatment facilities do not accept patients with complicated medical history. "These are patients in the emergency room with medical problems — they're not admitted to any psych ward," said Marc Burock, director of Main Line Health's behavioral health system. "Even patients with eating disorders, even if they are not active or severe - most psychiatric departments turn them away. They have a lot of influence because there is not enough psychiatric care in the system."
Other patients wait days for placement because they are COVID-positive or because their mental illness has caused problems in an institution in the past.
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"We have had people in our facility that we have declared stable for months and they have nowhere to go. Some patients are not welcome here because of challenges experienced in other institutions. [These facilities] are not required to accept referrals," Greenspan said.
He added that he has "a lot of empathy" for nursing homes, substance abuse rehabs and other residential care providers that accept psychiatric patients. He said many are simply not equipped to handle higher-level health care needs. However, this means that patients in desperate need will have to wait longer for a bed.
During the pandemic, Einstein increased the capacity of its crisis center, where patients with mental health crises go for immediate treatment. But even so, it could only admit 15 patients at a time. Sometimes, he said, these patients would wait up to 24 hours for treatment; patients only have to spend an average of six hours there.
Like many other hospitals in the city, the crisis center was often in a state of "diversion" during the fire, meaning that it ordered the police and paramedics to take patients elsewhere because there were no space for them. According to Greenspan, patients were still able to enter the hospital emergency room or the regular medical floor, but they were still forced to wait for patient entry in a busy and stressful environment that was not designed for his care
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According to Greenspan, as the number of COVID cases has decreased, the pressure on the crisis center has decreased. "I hope this is more than temporary," he said.
Burock and Main Line doctors began active psychiatric treatment of patients waiting for beds in the emergency department. They started giving meds and started telehealth therapy to make the wait more effective.
Jefferson Health-Abington's 16-bed psychiatric unit can treat behavioral health patients with other medical conditions. But the unit is usually always full. Even before the pandemic, the hospital began converting some of its emergency rooms to accommodate people with psychiatric problems as inpatients.
"They're regular rooms, but basically they have a garage door that we take down to hide all the equipment with ropes, bullets or anything else that's a tying risk," said Gerard Cleary, Abington's Chief Medical Officer. "Since the pandemic, we have used it more - and we do not have infinite capacity for these types of rooms. The demand is constantly growing."
Orange County Behavioral And Mental Health Treatment Centers
Jordan, who works with hospitals around the state, said HAP makes better access to behavioral health treatments a priority. The organization is particularly interested in finding community resources to help patients avoid the hospital altogether.
"Adequate housing support, crisis services, job placement services can reduce the pressure on inpatient beds," he said. "In the context of behavioral health, it's never an instant fix — it takes money, infrastructure and manpower to be identified and trained. But... if we don't fix it now, we never will." The demand for mental health services for young people is higher than ever, with Ramsay Mental Health launching the first private, dedicated inpatient service for school-age children in New. South Wales.
Northside Group St Leonards Clinic's adolescent and young adult service will provide 13 new private rooms for 14-18 year olds and will increase the number of private rooms for 18-25 year olds to 19.
Northside Group St Leonards Clinic medical director Dr John Kasinathan said it was important for Ramsay to open an inpatient service for teenagers because of the high need for mental health interventions in this age group.
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"I think teenagers and young adults 'get it'. They understand that mental health is the biggest issue facing teenagers and young adults in Australia. "Suicide remains the leading cause of death in this age group age, and "getting" that treatment can help a lot," said Dr. Kasinathan.
"The new and extended inpatient ward for adolescents and young people is conveniently located on the same floor as Northside Group's bespoke and modern clinic in St Leonards. We have tailored mental health care and treatment to these age groups, and they really like their new space here,” he said.
According to the NSW Mental Health Commission, one in four Australians aged 16 to 24 have a mental disorder and 1 in 3 experience moderate or high levels of psychological distress.
Ramsay Mental Health Australia director Anne Mortimer said she was delighted to open the state's first private mental health unit for 14-18 year olds.
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"The current demand for mental health services in this age group is high and we are committed to reducing the burden on our young people by offering high quality and quickly accessible services," Ms Mortimer said.
"We have also expanded our Young Adult department to be able to help this age group with mental health issues through our inpatient and day programs."
During their stay at the Adolescent and Young Adult Service, patients can use group psychological therapy and individual reviews
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