The number of psychiatric beds have declined precipitously in American over the past several decades. Some think that the decline is primarily due to insurance companies. Others blame Reagan and other politicians. I will discuss the multiple factors in another post. In part 1 of this series of articles, I shared how I learned what Critical Access Hospitals are and how earning that designation can save a hospital while reducing beds, including psychiatric beds. Here, in part 2 of this series, I share a fictionalized version of a conversation I had with multiple people in which I was arguing to reduce beds in a state hospital — something I never thought I would do — in the interest of safety.
2010
I am the medical director at a 130-bed state psychiatric hospital, a place that used to be much bigger, with a few thousand beds just a few decades ago. A social worker was almost assaulted by a patient. I call the my superior who who hired me in this role and who has oversight of multiple state hospitals. We discuss the assault incident.
Then, even though I know the answer, I ask, “Is is there any chance we can hire more staff? You know we have been short staffed for a while.”
I am not surprised when she says, “You know that’s not possible, Dr. Raina. The state’s budget is shambles. Heck, this fiscal year’s budget should have been passed 9 months ago. Our legislators don’t seem ready to make all the hard choices that must be made.”
I am sorry. I knew the answer to my question. I really don’t think our current staffing lessons are safe. I have a proposal for how we can achieve safe staffing levels without hiring more people. You wanna hear it?
Sure. I think I know where this is going. But, go ahead.
I believe that the minimum step we should take is to close one of our six units, even if as a temporary measure. Then let’s reassign the psychiatrist, social worker, nurses and mental health techs from that unit across the remaining units. We will still be short, but not dangerously short.
I don’t think that’s going to be approved.
Why not?
There are multiple stakeholders who will oppose it.
Why?
Because it’s going to cause them to worry that it’s a sign of downsizing and layoffs. It’s easier to cut funding for outpatient services than to even be perceived as downsizing hospitals.
Aren’t they worried right now about the safety of the employees and patients?
They are. But they will support hiring more people, not closing units.
Who are these stakeholders who would oppose closing one unit temporarily for safety?
There are all sorts of them. Union leaders. Politicians. Bureaucrats. They are are well-meaning people. But they just don’t want be the ones seen as supporting decisions likely to be seen as unpopular.
“Can you at least try?” I plead one more time.
She promises to try to make the case. I don’t know if and how hard she tried. But the proposal is not approved. After a few more unsuccessful attempts to persuade the higher ups to do either give us more resources or reduce our beds, and after many sleepless nights worrying about the safety of patients and staff at the hospital, I transition out of that role.
I learn more than a year later that after a couple of more incidents of patient and staff injuries, a couple of psychiatrists took early retirement. The the hospital did go on to close one unit.
