Closing psych beds

[Old RN]

Does anyone have experiences they can share with negative results in a general hospital when psych beds are closed? (For example, psych patients being held for long periods of time in the ED.)

[RN-PA, RN]

We're about to find out, Old RN. Our hospital closed their 18-bed psych unit in mid-July to make way for what will ultmately be an overflow Med/Surg unit. (The powers-that-be want to make it an "Orthopedic Excellence" and CVA unit, but with malpractice insurance running sky-high in PA, there aren't going to be any orthopedic surgeons left to practice in our area-- Most either can't operate or are moving to more hospitable states... )

[Old RN]

So how is that impacting the hospital at this point? Where are the pts. going? Are you using sitters? ED back ups? Other issues? Our hospital is talking about this based purely on $$ issues, not clinical issues. I need some real-world feedback for them! (Sounding desperate...)

[researchrabbit]

My sis works at a hospital where they have closed all the psych beds. A lot of these patients wind up on other floors, depending on additional medical problems. They have had trouble with nurses being assaulted, OTHER PATIENTS being assaulted (now there's a nice lawsuit for your hospital), psych patients endangering themselves. Some do require sitters.

[RN-PA, RN]

If I remember correctly, there is a "Crisis Team" in our E.D. and the patients needing inpatient care will be held (if possible) until transfer to another facility is available. There were many protests and articles and letters to the editor in our local newspaper against the closing, but because of financial problems, the hospital board thoght this would be best for the hospital. A shame, I know, but they felt there was no other way, and we really need more Med/Surg beds desparately.

We already had/have patients on our Med/Surg floor who needed to be on the psych unit but either refused or weren't medically stable to go there. We use sitters for those on suicide precautions or other behavioral issues that need 1:1. I haven't heard what the impact has been to be without a psych unit so far...

[Old RN]

Thanks for your very helpful comments. I hope I will hear from some other RNs who can speak to the internal and external impact of closing. I will also post in the ED nurses' section.

[Orca, ADN, ASN, RN]

Las Vegas has lost numerous psych beds, especially adult, over the past two years. This city seems to be a haven for schizophrenics, and it feeds the cravings of those with uncontrolled bipolar disorder and various addictions and compulsions - not a good place to have a shortage of psych beds.

First was the Charter Behavioral Health fiasco which many of us were caught up in. I was the charge nurse on duty when the last patient left Charter Las Vegas after corporate closed us, and took our 84 beds out of the market. A couple of years later, I was offered a job at another hospital, working for a friend from my Charter days on the adult psych unit. I was literally in HR filling out the last two pages of my employment packet and about to have my ID badge made when word came down that the hospital was closing the adult psych unit and turning it into med-surg beds. Adult psych management was not told that this was coming.

Hospitals are deciding that surgery is much more profitable, and the liability risks are too high in psych for too little return. Many of the people who hit psych units are people of little or no means (and frankly, some fake suicidal ideation or hallucinations just to make their welfare checks go farther or to get off the streets for a while).

It is unfortunate, but financial reality is robbing this city (and many others) of badly-needed mental health beds. A recent article in the newspaper said that the mentally ill are backing up in local emergency rooms waiting for a bed to open at a local mental health unit - which sometimes takes days. This adds to the difficulties faced by already-overloaded emergency medical services.

In a city with a million-and-a-half people (not counting about 200,000 tourists at any given time) that is growing at the rate of 6,000 residents per month, there is one private facility and one hospital that offer inpatient adult services, one private facility for children and adolescents, and two hospitals that offer geriatric services. That's it (besides an overtaxed state facility).

[Old RN]

Orca, thanks for your reply. I am waiting to see what will happen to our psych beds and if they will close all, or part, or just what.