Study explores supply-side options to increase access to state psychiatric hospital beds

December 1, 2015

When patients with mental health needs cannot be properly treated through outpatient or general hospital care, state psychiatric hospitals act as the ultimate safety net.

These state facilities are specifically designed and staffed to care for people with severe mental illness. Such hospitals can competently see patients through immediate crises as well as longer-term rehabilitation – unless those patients can’t access care due to a lack of hospital beds.

Dr. Elizabeth La

In an attempt to find solutions for long wait times for beds, Elizabeth La, PhD, a recent graduate of the Department of Health Policy and Management at the UNC Gillings School of Global Public Health, conducted a study that simulated the flow of patients through one of North Carolina’s three state psychiatric hospitals.

Her research, which was funded in part by a Gillings Innovation Lab grant awarded to Principal Investigator Joseph Morrissey, PhD, professor of health policy and management at the Gillings School, used computer modeling to explore the supply-side (hospital-based) changes that would be required to reduce patient wait times under three days, two days and one day.

The findings, released in a paper titled, “Increasing Access to State Psychiatric Hospital Beds: Exploring Supply-side Solutions,” were published online Dec. 1 by the journal Psychiatric Services.

“Understanding shortfalls in mental health systems and developing decision support tools to help stakeholders test alternate policy options in response to these shortfalls are critical first steps,” said La, who has worked since graduation in 2014 as a senior research health economist at RTI Health Solutions. “This kind of analysis helps ensure that individuals experiencing psychiatric crises are able to access care in a timely manner.”

A series of nine meetings with hospital stakeholders found that the total number of staffed beds at the N.C. study facility was fixed at 398, with the beds divided among multiple units serving patients with different needs.

After looking into cost-neutral scenarios to accommodate shifting patient mixes, researchers found that most units were constantly at or near capacity, and shifting beds between units was not a viable solution for the larger wait time problem.

Overall, study results indicated that a large number of additional state hospital beds would be needed to make any substantial impact on the average wait time of admission for people in crisis. Reducing the wait time below one day at the study hospital, for example, would require a nearly 165 percent increase in bed capacity.

While recent legislative proposals in N.C. have called for the construction of a fourth state psychiatric hospital to increase system-wide capacity, authorizing legislation has yet to be enacted.

Meanwhile, La and her co-authors recommend alternative solutions that could augment psychiatric hospital bed additions as part of a comprehensive resource optimization model.

One proposal suggests that state administrators also look into increasing bed capacity for mental health patients in community general hospitals and freestanding crisis facilities. A second option involves expanding intensive outpatient services to reduce the total need for beds.

Ultimately, the study found, supply-side changes are only a partial answer to the growing problem of excessive wait times for psychiatric inpatient care.

“In the absence of more robust community-based services, this study sheds light on the substantial number of state psychiatric hospital beds that are needed to ensure timely access to care,” La said. “The simulation model further could be used to explore demand-side solutions, providing a better understanding of the system as a whole and additional leverage points for improving care.”

Study co-authors affiliated with the Gillings School include Alan R. Ellis, PhD, MSW, Adjunct Assistant Professor of Epidemiology; Kristen Hassmiller Lich, PhD, research assistant professor, and Joseph Morrissey, PhD, professor, both from the Department of Health Policy and Management; as well as Ruoqing Zhu, PhD, a recent graduate from the Department of Biostatistics.