The COVID-19 pandemic has reshaped healthcare systems worldwide, forcing hospitals to make difficult decisions about how to allocate resources. One of the most concerning consequences of the pandemic has been the loss of psychiatric and substance use disorder (SUD) treatment beds. As hospitals have been forced to repurpose these beds to accommodate an influx of coronavirus patients, a growing number of individuals struggling with mental health issues are finding themselves unable to access critical care. This has contributed to a sharp increase in overdoses and suicides, particularly in states like New York, which once held the title of the nation’s worst COVID-19 hotspot.
New York’s crisis has become a glaring example of the severe challenges faced by healthcare systems across the country. The closure or repurposing of psychiatric and SUD beds has raised alarm bells among mental health professionals, healthcare workers, and families of those affected. In many cases, patients who do manage to get treatment are being discharged prematurely, leaving them without the necessary support to maintain their recovery. This troubling trend has led many to wonder: what will the long-term effects be if the loss of behavioral health services becomes permanent?
The Impact of Bed Closures: A Critical Shortage of Behavioral Health Care
Amid the pandemic, hospitals across the United States have had to make room for COVID-19 patients, leading to the closure or repurposing of a significant number of psychiatric and SUD beds. In New York State, where the pandemic hit hardest during the spring and early summer, the shortage of behavioral health services has been particularly pronounced. According to state data reported by the Wall Street Journal, about 400 psychiatric beds and 150 SUD beds remain closed, and this has placed an immense strain on the state’s already limited mental health resources.
While the situation has improved since the height of the pandemic, when as many as 542 psychiatric beds and 403 SUD beds were lost, the current shortage remains significant. The loss of these beds creates a critical gap in care for individuals suffering from mental health disorders and addiction, leaving many with no place to turn for help.
“There are not enough providers, not enough beds, and not enough hands on deck,” said Abby Venzor, a therapist in New York, in an interview with The Wall Street Journal. This shortage is felt acutely by patients like the one Venzor treated, who was unable to find treatment at 10 different hospitals. This scarcity of resources is leaving individuals with nowhere to go when they need it most.
The Human Cost of Behavioral Health Bed Closures
The shortage of psychiatric and SUD beds has led to a troubling increase in patients being discharged prematurely from hospital-based behavioral health care. The practice, known as “early discharge,” is often a result of hospitals’ efforts to free up space for COVID-19 patients or simply due to limited availability of beds. However, these early discharges can have devastating consequences for patients who are not yet stable enough to leave care.
One such example is the case of Imani Fecu, who died of a likely heroin overdose in June. Fecu, who had schizoaffective and bipolar disorder, was discharged from Health + Hospitals/Kings County public hospital after only a few days of treatment in late March. Her grandmother, Sandra Lindie, told The Wall Street Journal, “She crashed and there was no safety net for her crashing.” Fecu’s story is just one of many tragic examples of patients who, after being prematurely discharged, are left without the support they need to recover.
Without the proper mental health and addiction treatment, individuals who are discharged prematurely are often left to fend for themselves. The lack of available beds means that patients with complex mental health conditions or substance use disorders are unable to receive the care they need to stabilize and continue their recovery. For many, this leads to a downward spiral of relapse, hospitalization, and, tragically, death.
The Risk of Permanent Bed Closures: A Financially-Driven Crisis
As the pandemic continues, there is growing concern that the loss of psychiatric and SUD beds could become a permanent fixture of the healthcare landscape. Hospitals are under significant financial strain, and with limited resources available, many are finding it more financially viable to prioritize patients with physical health needs, particularly those affected by COVID-19. Hospital administrators may be tempted to focus on the more lucrative areas of care, like treating COVID-19 patients, which could mean fewer beds available for those suffering from mental health and substance use disorders.
This shift in priorities has the potential to create long-term gaps in care for individuals with behavioral health needs. Even once the immediate threat of COVID-19 has passed, there may be fewer resources dedicated to mental health and addiction treatment, leaving millions of people with nowhere to turn for help.
“The loss of psychiatric and SUD beds is something that could become permanent because of the financial pressures on hospitals,” said Venzor, the therapist from New York. “If they are financially incentivized to provide care for COVID-19 patients, and the reimbursement rates for behavioral health services are lower, it’s likely that behavioral health beds will be the first to go.”
This financial dilemma places hospitals in a difficult position. While hospitals are often able to secure higher reimbursement rates for physical health treatments, behavioral health services, particularly inpatient psychiatric and addiction care, tend to be underfunded. This makes it difficult for hospitals to justify maintaining behavioral health beds when financial resources are tight, even in normal times, let alone during a pandemic.
The Ripple Effect: Community Behavioral Health Providers Strain Under Pressure
The shortage of hospital-based behavioral health beds is not just affecting the hospitals themselves; it’s also having a significant impact on community-based behavioral health providers. These organizations are already stretched thin, dealing with an overwhelming demand for services and limited resources. As hospital-based care becomes less accessible, more individuals are turning to community providers for help.
However, these community-based providers are facing their own challenges. According to a National Council for Behavioral Health survey conducted in September, more than 65% of respondents reported having to cancel, reschedule, or turn away patients due to the overwhelming demand for services. This is further exacerbating the strain on the already underfunded behavioral health system.
Community providers are often forced to pick up the slack when hospital-based care is unavailable, but they are doing so with limited resources and a shortage of trained professionals. Many are struggling to keep up with the demand, leading to long wait times, diminished quality of care, and, in some cases, the inability to provide services at all.
Rising Overdoses and Suicides: A Public Health Crisis in the Making
The consequences of these shortages are being felt most acutely in the rising rates of overdose deaths and suicides. According to the Centers for Disease Control and Prevention (CDC), the United States saw a significant increase in drug overdose deaths during the early months of the pandemic. Early data indicated that overdose deaths were up by nearly 30% compared to the same period in the previous year. This increase in overdoses was exacerbated by disruptions to addiction treatment services, including the closure of psychiatric and SUD beds in hospitals.
Similarly, suicides have also increased, as people struggling with mental health issues find themselves unable to access the support and treatment they need. Isolation, economic stress, and the overall strain of living through a global pandemic have contributed to rising rates of mental health crises. However, without access to timely care, many of these individuals are left to cope with their struggles in silence.
A Call to Action: The Need for Greater Investment in Behavioral Health Services
The loss of psychiatric and SUD beds during the COVID-19 pandemic has underscored the need for greater investment in behavioral health services. As the pandemic continues, the consequences of this crisis are becoming increasingly clear. Hospitals, community-based providers, and policymakers must work together to ensure that individuals with mental health and substance use disorders have access to the care they need, particularly during times of crisis.
There are several steps that can be taken to address this issue:
- Increasing funding for behavioral health services: One of the primary drivers behind the closure of psychiatric and SUD beds is the financial strain on hospitals. Policymakers should prioritize funding for mental health and addiction treatment services, ensuring that these services are adequately reimbursed and that hospitals are incentivized to maintain behavioral health beds.
- Expanding access to community-based care: As hospitals become overwhelmed with COVID-19 patients, community-based behavioral health providers will continue to play a critical role in filling the gaps. Increased investment in these providers is essential to ensure they can meet the rising demand for services.
- Developing telehealth options for mental health care: Telehealth has emerged as a valuable tool during the pandemic, providing patients with the ability to access mental health care remotely. Expanding telehealth services can help bridge the gap in care, particularly for individuals who are unable to access in-person treatment.
- Prioritizing mental health and addiction services in public health responses: Mental health and addiction care should be prioritized as part of public health responses to the pandemic. This includes ensuring that individuals with behavioral health needs have access to safe, timely, and effective treatment options.
Conclusion
The COVID-19 pandemic has exposed the fragility of the behavioral health system in the United States. The loss of psychiatric and SUD beds in hospitals, combined with the rising rates of overdose deaths and suicides, has created a public health crisis that requires immediate attention. As we move forward, it is crucial that we invest in behavioral health services and ensure that individuals in need of care can access the treatment they require, both during and after the pandemic. If we fail to act, the consequences will be felt for years to come.
