Study: Wait times for psychiatric beds still 'excessive'

The number of Forsyth County behavioral-health patients experiencing a long wait for a state psychiatric hospital bed remains stubbornly high, according to a study by a Raleigh advocacy group.

"There has been a major effort to reduce the numbers waiting for a bed by increasing the number of state-funded community psychiatric beds," said Gerry Akland, a co-author of the study that was released this week by the Wake County chapter of the National Alliance on Mental Illness.

"Unfortunately, the numbers are not going down and wait times are excessive," Akland said.

The study gives a breakdown of wait times for 12 medical facilities in the central part of North Carolina for the second quarter of 2011.

There were 113 patients placed on a wait list in Forsyth County between April and June of 2011, including 49 who waited at least three days and 17 who waited at least seven.

Wake Forest Baptist Medical Center served 67 of those patients — the sixth-highest amount of the 12 medical facilities. Eleven of those patients were held at least seven days. Only Duke Medical Center had more seven-day waits, at 15.

A wait of at least seven days is considered statistically significant by health-care officials because it is a time period in which most patients have either stabilized and been released, or are in the process of being transferred to a state hospital for chronic needs.

However, the chapter cautioned that "if the person is stabilized, taken off involuntary commitment and returned home, it is reasonable to assume that many will not be connected with community mental-health providers for follow-up care."

The longest individual wait at Wake Forest Baptist was nearly 30 days — the longest of the 12 facilities. Wake Forest Baptist officials declined to comment on the report.

Forsyth Medical Center had 39 people on a wait list, with 15 patients there at least three days and six at least seven days. The longest wait time was 17½ days.

For Old Vineyard Behavioral Health Services, there were seven on the wait list, of which four were there at least seven days. The longest wait was nearly 28 days.

In the past two years, Forsyth added at least 11 beds to its locked adult psychiatric ward unit for a total of 55. It also has 10 secured private beds in its emergency department.

Todd Clark, director of behavioral-health services for Forsyth, said behavioral-health admissions rose steadily during 2011 from 149 for the first two weeks of January to 219 for the last two weeks of December.

"Changes we've made internally in handling behavioral-health patients have reduced the average wait time from 38 hours at the start of 2011 to below 20 hours now," Clark said. "A quick-look process with a behavioral-health team has cut down the time that a patient is first seen from 4½ hours to 18 minutes."

Old Vineyard gained 50 beds for a 24-hour psychiatric emergency department in September from state-run Broughton Hospital.

Kathy Murray, director of business development for Old Vineyard, said the 50 new adult acute-care beds have been nearly filled to capacity most nights.

"All is going very well in regard to transportation of patients to and from Old Vineyard," Murray said.

In many instances, the patient has been taken into custody through an involuntary commitment. In such cases, state law requires a law-enforcement officer stay with the patient until it is determined a doctor or eligible psychologist is available to do an examination.

The NAMI chapter estimates community hospitals spend an average of $1,000 a day on holding someone on involuntary commitment in the emergency department.

People having a behavioral-health problem tend to spend their wait in beds and are given short-term medical and mental-health care. Some are restrained if they are considered dangerous to themselves or others.

Capt. Patricia Murray, of the Winston-Salem Police Department, said police handled 157 more cases involving behavioral-health issues in 2011 than in 2010.

She said she believes the opening of the additional beds at Old Vineyard led to some of the increase because the community realizes there is another care option.

"We have developed such relationships and contacts with those facilities that we are now able to simply pick up the phone or send an email to the appropriate person and are able to quickly address any concerns or issues," Murray said.

Clark said that even as Forsyth's behavioral-health policy is being copied by other Novant Health Inc. facilities, he recognizes the policy is limited by community factors.

"It's a failure when the behavioral-health patient enters the emergency department as a portal to behavioral-health care rather than them being treated in the community well beforehand," Clark said.

Michael Cottingham, a spokesman for CenterPoint Human Services, which oversees behavioral-health providers, said the agency has established a specific schedule for care coordinators to be on-site at Forsyth and help hospital staff "assure that consumers access the least restrictive appropriate care environment."

Cottingham said the 50 new beds at Old Vineyard have helped reduce pressure by "providing a much-needed resource for those with private insurance so that the care in the community hospitals are more available for those funded by Medicaid or CenterPoint."

"We are continuing to brainstorm with hospitals and law enforcement on novel approaches to address the issue," he said.