Report calls for more inpatient treatment for the mentally ill

The number of state hospital psychiatric beds dropped by 14% nationwide from 2005 to 2010, pushing the severely mentally ill into emergency rooms, jails and prisons, according to a report advocating for more inpatient treatment.

The report, released Thursday by the Treatment Advocacy Center , lauded the decades-old goal of treating patients in community facilities whenever possible, rather than institutionalizing them.

However, the discharge of hundreds of thousands of people has proved to be disastrous, said the report, noting that “95% of the nation’s public psychiatric hospital beds [have] disappeared, but community psychiatric care exists for fewer than half the patients who do need it.�

In California, state hospitals served 5,283 patients in 2010, down 16% from five years earlier. The vast majority of those beds, about 92%, now are filled by patients from the criminal justice system and are no longer available for those in need of civil commitment.

A 1999U.S. Supreme Courtruling that required public entities to administer psychiatric services and programs in the “most integrated setting appropriate� accelerated the trend to deinstitutionalize those not under the jurisdiction of criminal courts. The case also applied to people with developmental disabilities.

Doris Fuller, executive director of the Treatment Advocacy Center, said states have used the case as an excuse to phase out institutions.

The court decision made it clear that states should not be forced to release patients too ill to care for themselves, she said, but it “has widely been used mistakenly as a justification to do just that.�

The center’s report called on states to stop reducing the number of psychiatric hospital beds until adequate community alternatives are in place, and encouraged the use of court-ordered outpatient treatment for those too sick to seek help. It also recommended for coverage under Medicaid — known in California as Medi-Cal — for state hospital patients.

While states cover an average of 79% of the cost for their hospital patients, they pay an average of 55% when patients are transferred to community treatment, the report said.

The report did not examine the availability of psychiatric beds for the acutely ill in county or privately run facilities. According to the California Hospital Assn., the number of those beds dropped by 30% between 1995 and 2010.

At issue is an ongoing philosophical debate about the most dignified and effective way to treat the mentally ill.

TheU.S. Department of Justice, for example, has pressed for comprehensive community care in place of a return to institutionalization.

Asked to comment on Thursday’s report, Alison Barkoff, special counsel for the department’s civil rights division, said in a statement: “As the Supreme Court has recognized, unnecessary segregation of people with disabilities in institutions, including psychiatric institutions, is, itself, discrimination and is harmful.�

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