Timely access to psychiatric beds in acute care hospitals is an essential and critical service for people suffering from serious mental illness—sometimes with a concurrent substance use disorder and family members—who cannot safely or appropriately be treated as outpatients.
Good community services and resources for people with serious mental illness and families and caregivers are essential, but they are not enough. These services and resources may reduce the overall need for hospitalization, but they cannot replace acute inpatient care. Some people with serious mental illness must be involuntarily admitted to hospital under the Mental Health Act, others voluntary seek hospital care to seek support for their increased inability to cope with their mental illness. Causes for both these situations include the potential of relapse, need for medication changes, or a change or increase in physical stressors that can cause psychiatric symptoms – which can include a complex concurrent substance use disorder. Without access to hospital beds in psychiatry, serious harm can occur to the ill person and to those who care for them and about them.
Families seeking support from BCSS often tell us about the challenges they face in helping their loved one seek acute care because of the lack of beds available. This leads BCSS to seek support and changes leading towards an increased number of psychiatric beds.
BC Schizophrenia Society and BC Psychiatric Association often hear serious complaints about bed shortages. This initiated the need to create this joint report to examine and bring to light some of the most familiar and troubling elements of the health care system for British Columbians dealing with chronic and severe psychiatric illness – whether it is family members, caregivers, or the individual needing help themselves.
A study released in November 2019 by the Treatment Advocacy Center warns that Americans who visit emergency rooms with psychiatric problems have a higher rate of being dumped or being “boarded” than those without mental illnesses.
A patient in the midst of a heart attack would not be left to languish because treatment is unavailable or inconvenient. The notion that such an individual could be set aside, and his or her condition allowed to deteriorate to the point that recovery is less attainable, would be unthinkable. However, for people with mental illness, society and systems have made the unthinkable a reality.
As a consequence of inadequate preventive treatment options in the community, diminishing supplies of higher levels of care and other factors, individuals in psychiatric crisis present to local emergency departments and wait for treatment. Emergency departments are thus flooded with individuals seeking help for conditions that could be better addressed elsewhere in a functioning system of care. The evidence presented shows that serious mental illness is a significant contributor to emergency department boarding, and any solutions to combat psychiatric boarding must address treatment gaps for individuals suffering from these conditions.