The Psych Bed Crisis in Denver

While the recent financial crisis has largely held the health care industry harmless, not all classes have providers have managed to capture a piece of double digit health insurance price increases year ater year.

Denver's psychiatric hospitals have been catastrophically cut in the past two decades, despite a growing metropolitan area population and no sign that the mental health of our region's people is getting any better. "About 40,000 mentally ill people show up in Colorado emergency rooms each year, statistics show. Of those, about 40 percent need hospitalization."

While there as a major deinstitutionalization of the mentally ill in the 1960s, most agree that while there were too many institutionalized mentally ill people in 1955 (about 340 bed per 100,000 people), that deinstitutionalization went too far. Now, many people who should be receiving institutionalized mental health treatment homeless, in jails and prisons, and cycling through expensive emergency rooms.

Metropolitan Denver has 700 psychiatric hospital beds in 1990. Now it has 230. Colorado is 50th among the 50 states and District of Columbia, in psychiastric hospital beds per capita.

Psychiatric hospital beds aren't cheap. The University of Colorado, which recently shut down its twenty-one bed psychiatric hospital spent $80,000 a year per bed to operate its facility.

Colorado has 11.8 psychiatric beds for every 100,000 people, while nationwide the average was 30.

The shortage of beds is bad enough that in November the state hospital at Pueblo had to turn away patients for nearly a week.

The hospital, which has eliminated more than 60 percent of its beds since 1990 because of budget cuts, had no choice, said Liz McDonough, spokeswoman for the state Department of Human Services, which oversees state hospitals. . . .

CU is hardly the first hospital to close its psychiatric unit. Heather Cameron, director of the Triage project, said the group found at least eight hospitals that had closed units in the past decade or so, including Presbyterian/St. Luke's and St. Anthony Central.

St. Anthony's closed in 2005; that year, the unit lost $3 million, said David Thompson, who became the hospital's chief financial officer after the closure.

The loss didn't come because the unit's 29 beds sat empty. On the contrary, "It stayed full. There definitely was a demand," Thompson said.

What was missing was payment for the care.

"The majority of patients did not have insurance," Thompson said.

At Denver Health Medical Center, 960 adults were admitted for inpatient treatment in 2007. Of those, 55 had private insurance, said Dr. Robert House, behavioral health director at Denver Health.

In November, Dr. Patricia Gabow, Denver Health's chief executive, warned that the number of uninsured patients might force the hospital to cut services — including mental- health care — in the coming year.

With University and St. Anthony hospitals shuttering their units, Gabow worries that the strain of psychiatric care, especially for indigent patients, could stretch their resources to the breaking point.

The hospital recently added a 10-bed psychiatric emergency unit, and it operates a 44-bed adult inpatient psychiatric unit.

Even when patients have insurance, there is no guarantee against losing money taking care of them.

At St. Anthony, insurance "reimbursement rates just weren't up to par. They just didn't cover the cost," Thompson said.

Many insurers require hospitals to provide almost daily justification for continuing treatment, and even then limit what they will cover, Most said.

"We have to beg sometimes every day to keep a patient in the hospital," Most said. "We have staff dedicated to just that."

Sometimes the insurers win and the results can be tragic. In one sad wrongful death case where I represented a mental health patient's survivors, the patient didn't want to leave, didn't have a good discharge plan, and committed suicide within 48 hours of being discharged.

While all areas of the health care system have deep seeded and intactable problems with patients who can't afford health insurance or pay for care out of pocket, there a few places where the problem is more accute than psychiatric hospital care. A system based upon employer provided health insurance, and on individual policies that often provide little or no mental health care coverage, simply does not serve this need well.

Even if a system of near universal health insurance through employers, supplemented with means tested subsidies, can work passably well for much of the nation's health care needs, this may not be a system that works to meet the needs of those requiring in patient mental health treatment. Given the grave costs of denying health care in this circumstances to patients, to their families and to the larger public handling this part of the health care system on a single payer basis may make sense.

The Denver Post offers as a public service, and I repeat, a list of the Denver area psychiatric hospitals with their respective capacities:

Where to find hospital care:
Key metro-area hospitals licensed to provide adult inpatient psychiatric treatment, including patients involuntarily committed:

• Boulder Community Hospital: 10 beds

• Centennial Peaks Hospital, Louisville: 30 beds

• Colorado Mental Health Institute at Fort Logan, Denver: 153 adult beds*

• Denver Health Medical Center: 44 beds

• Exempla West Pines, Lutheran Medical Center, Wheat Ridge: 38 beds

• Highlands Behavioral Health System, Littleton: 56 beds

• Porter Adventist Hospital, Denver: 35 beds

*Does not include beds for those committed through the criminal justice system