Region battles shortage of mental-health beds

Ten years ago, the situation had become acute: Hospitals around the nation were shutting down their psychiatric units, leaving mentally ill patients in need of crisis support virtually out in the cold, or at least waiting in emergency rooms for someplace to go.

Crisis support for the mentally ill functions much as an emergency room does, except that instead of treating physical injuries, patients with behavioral issues are given social and psychiatric support as they work through the issues that have put them in a crisis. Usually, they receive such support for from seven to 10 days before most are reintegrated into residential or outpatient treatment.

But by 2008, the situation in Colorado was critical: A survey by the American College of Emergency Physicians ranked the state last in the nation for the number of inpatient psychiatric beds per capita. The survey found Colorado had about 12 psychiatric beds for every 100,000 people, while nationwide, the average was 30.

Most experts believe the average should be 50 beds per 100,000 residents.

Whether the state has made up all that lost ground is up for debate. The state and private sector have made significant steps in taking up the slack, but not everyone is convinced that all is well in accommodating mentally ill patients in crisis, especially those with substance-abuse problems.

“Essentially, our company found there was just a tremendous need in (all of) Northern Colorado, so we were looking for a spot that was centrally located,” said Ethan Dexter, community liaison for Clear View Behavioral Health, a 92-bed crisis facility located in Johnstown, just southeast of the interchange of Interstate 25 and U.S. Highway 34.

The facility has 24 beds available now, as it hires and trains employees to service patients, but it hasn’t had trouble filling those beds, Dexter said.

“We’ve been getting calls from all over Colorado and Wyoming,” Dexter said. “We’re getting calls from as far south as Pueblo and the Western Slope — from as far as Grand Junction. We are maintaining a fuller hospital, but we don’t generally have to turn away patients because of space.”

In 2014, the state of Colorado made about $24 million available in grant funds for walk-in mental-health treatment, including what are termed as Crisis Stabilization Units. Currently, there are 15 walk-in centers, although only one on the Western Slope. Eight of them have CSUs with a combined total of 120 beds. While not all CSU beds provide the extensive services of psych units, they are considered to be an alternative in many cases.

In Boulder County, Boulder Community Hospital supports 10 psych-unit beds, and Centennial Peaks Hospital in Louisville has 72 beds and is now expanding to 100. Farther north, there does appear to be a dearth of psych units. There are four Colorado Crisis Center walk-in facilities, but only 10 CSU beds now listed on the center’s website.

Clear View’s parent company, Strategic Behavioral Health LLC, now maintains 11 such facilities across the United States, including Peak View Behavioral Health Hospital in Colorado Springs. While the company is ramping up as quickly as possible, Dexter said, the biggest challenge is not in building a facility but rather in staffing it.

“Our philosophy is, we won’t accept more patients than we are capable of serving safely,” he said. “If we did have 92 beds (open), we would have to have between 240 and 250 employees trained and ready to go.”

Some staffing requirements are absolute, he said, such as maintaining a nursing ratio of one nurse per 10 patients and a medical technician ratio of one to six. With a live-in facility, there are also food service, custodial and security personnel, but Dexter said the most difficult positions to fill are supervising psychiatrists.

Boulder County also has a relative wealth of alternatives to locked-down facilities, such as the Mental Health Partner’s Warner House, which can serve acute psychiatric needs for as many as 16 people in a more homelike setting. Originally called the Cedar House, it was created to “control ballooning in-patient costs,” according to company information.

Also in Boulder, The Lookout-Boulder can serve as many as 20 people in a similar environment, but one which is geared more toward addiction or dual diagnosis (mental health and addiction).

But these are not locked-down facilities, nor can they handle medical detoxification, said Mara Lehnert, founder and executive director of The Lookout, along with more transitional homes in Louisville, Choice Homes, and Lafayette, Ladies Choice.

Lehnert noted that Harmony House in Estes Park, where she previously was the director of intervention, is creating a detox facility, but finding affordable locked-own beds, especially for dual-diagnosis patients who may be using, is somewhat of a continuing nightmare.

“It’s an absolutely horrendous situation,” she said. “If a guy falls into crisis, we are racing the clock looking for a crisis bed somewhere. Almost all the time, there isn’t a bed available. What we have to end up doing in taking them to some emergency room somewhere, and usually we can’t get a hold placed on them unless they are specific about being homicidal or suicidal.”

Often, the 72-hour holds end up being far less than that, she said. In a recent episode, a woman had cut her thigh open to expose an artery and was released from an ER in only 12 hours.

Even the state-funded CSUs, she said, which don’t necessarily provide all the services of a traditional psychiatric hospital, require a trip to the emergency room

“I’ve almost never heard of anyone who didn’t have to spend literally hours waiting in the ER,” Lehnert said, recalling a father who spent eight hours waiting for a social worker to see his disturbed son.

Still, the situation has been improving since six years ago, when Northern Colorado was almost cleared of psych beds, said Ann Matino, who has spent 25 years administering local programs. She noted that Centennial Peaks, which has been in the same location for 26 years next to Avista Adventist Hospital, is the exception rather than the rule in an industry that seems in constant change.

“Obviously, Clear View and Centennial Peaks expanding is an indication that there’s a real need here,” she said.

But Matino suggested that just as often it’s relatively easy to find a bed as not, but whether it works out is defined by a host of factors, most important being the ability to pay. Intensive care in some private psych units can run upward of $1,800 a day, a cost many insurance plans will not cover.

“For instance, Medicare will pay for mental health but mostly not for detox,” she said. “It is frustrating when someone is stuck in an ER. It’s expensive — though it is safe. When it’s extremely difficult getting (into a psych unit), well that’s bad.”

That’s probably the reason why Clear View’s next move will be opening up a detox center.

“We are in the middle of getting our license to start treating chemical dependency and detox. We hope to achieve that by March,” Dexter said. “We are hoping to open our geriatric unit by May and open our adolescent unit by September.”

on Facebook on LinkedIn