Access to behavioral health services may be a growing challenge in many communities as psychiatric hospital occupancy rates reach their highest levels in more than five years, according to annual survey data released by the National Association of Psychiatric Health Systems (NAPHS). The trend is true for all types of programs, including child, adolescent, adult, older adult, and drug and alcohol programs. At the same time, the average length of stay reached a new low in all programs except those for children, which saw a slight increase.
"This turnaround is indicative of the growing demand for acute hospital care within all age groups and the reduction in capacity as beds have been closed in both the private and the public sectors," said NAPHS executive director Mark Covall in releasing the report. "Behavioral health caregivers are working harder with limited resources."
The NAPHS 2002 Annual Survey Report is based on responses to a questionnaire distributed in the summer of 2002 to more than 300 NAPHS member organizations, which include behavioral health specialty hospitals, general hospital psychiatric and addiction treatment units, residential treatment centers, youth services organizations, partial hospital services, behavioral group practices, and other care providers. The 2002 report analyzes data from 136 psychiatric facilities.
In 2001 the average hospital occupancy rate was 74 percent, a 7 percent increase over the 2000 rate, according to the report. The 2001 rate is 33 percent higher than the 1996 occupancy rate of 56 percent. Hospital admissions have also risen steadily over the past five years. In 2001 a typical hospital saw 2,350 patients—an 11 percent increase over the 2000 rate and a 56 percent increase over the rate of 1,500 patients in 1996.
The average inpatient stay declined from ten days in 2000 to 9.3 days in 2001. Hospital stays have plummeted by 57 percent over the past decade; in 1991 the average stay was 23 days.
Admissions paid for by Medicare and Medicaid accounted for 42 percent of all inpatient admissions in 2001, and 48 percent were paid for by all government programs combined. Funding from state governments has increased dramatically—up 65 percent from 2000 to 2001. Admissions paid for by state funding accounted for 4.8 percent of inpatient episodes in 2001.
The survey found a dwindling supply of partial hospitalization and outpatient programs offered by its member facilities. Sixty-seven percent offered partial hospitalization services in 2001, compared with 83 percent in 2000. Outpatient services were offered by 49 percent of the facilities, compared with 64 percent in 2000.
In residential care settings, which the report notes represent an important part of the continuum of care, especially for children, both admission rates and lengths of stay increased in 2001. In hospital-based residential treatment centers rose by 90 percent—from 95 residents in 2000 to 180 in 2001. The average number of days of care in these centers grew by 73 percent during the same period. Freestanding residential treatment centers reported a 28 percent increase in admissions, from 118 to 151 residents, and a 34 percent increase in days of care provided, from about 29,280 days to 39,200 days.
The NAPHS 2002 Annual Survey Report is designed for use by financial analysts, health care planners, consultants, hospital executives, and others needing detailed information about specialty psychiatric organizations. The report is available for $400 from NAPHS at 325 Seventh Street, N.W., Suite 625, Washington, DC 20004-2802.
In mid-February Congress passed an omnibus bill finalizing appropriations for federal health spending for fiscal year 2003. The National Institute of Mental Health (NIMH), the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism received substantial increases. The increases are part of a bipartisan effort to complete a commitment made in 1998 to double the National Institutes of Health (NIH) budget.
t1 shows the level of funding for federal mental health and substance abuse programs for fiscal years 2003 and 2002. Although Congress met the goal of raising overall NIH spending to $27 billion for 2003, percentage increases for several agencies and institutes this year lagged far behind those enacted in recent years. By way of comparison, t1 also shows the percentage increases from 2001 to 2002. The total SAMHSA budget grew to nearly $3.2 billion, an increase of less than 1 percent in this year compared with 6 percent last year. The 2003 levels of funding for substance abuse prevention and treatment were virtually unchanged from the 2002 levels.
The 8.4 percent increase for NIMH is below that of nearly 13 percent last year and below similar annual increases since 1999, reflecting the budget-doubling goal noted above. The reduced appropriations for the three institutes are attributable to the disproportionately large increases for bioterrorism research at the National Institute for Allergy and Infectious Disease and a reallocation of funds from NIH to the Centers for Disease Control.
Details about the final appropriations for fiscal year 2003 are available online at http://thomas.loc.gov (click on "Status of FY2003 Appropriations Bills" and then on "Labor/HHS/Education").
Guide for families on cognitive impairment: The New York State Office of Mental Health has released a 34-page handbook for families and friends of people who have problems as a result of mental illness. The book teaches families how to recognize the signs of cognitive dysfunction, because many families believe that cognitive problems end when hallucinations and delusions stop. The guide covers three treatment strategies for people experiencing cognitive problems—remediation techniques, compensatory strategies, and adaptive approaches and includes a checklist for helping an impaired person understand his or her learning style. A resource list of agencies and information is provided. Dealing With Cognitive Dysfunction Associated With Psychiatric Disabilities is available online at www.omh.state.ny.us.
Web site on tools and solutions for alcohol problems: A new research unit of the George Washington University Medical Center—Ensuring Solutions to Alcohol Problems—has created a Web site (www.ensuringsolutions.org) that offers research-based information and tools to help curb costs associated with alcohol use and improve access to treatment for Americans who need it. Among the resources are research reports, primers on alcohol treatment, fact sheets, research tools for assessing health plans and treatment services, and issue briefs for policy makers, business leaders, and concerned citizens. The project is supported by a grant from the Pew Charitable Trusts.