Saturday, October 4, 2008

The greatest health threat we're STILL not treating

A recent report by The Advisory Board titled "Future of Neurosciences" reveals that, while behavioral/mental health cases dwarf other admits by volume (in 2006, 10.1 million behavioral health cases versus 3 million cerebrovascular cases, the next largest neuroscience inpatient or outpatient admit in Advisory's study pool), it is not profitable ($1,759 profit per behavioral health case vs. $3,223 profit per cerebrovascular case).  Over 50% of psychiatric admits are through the emergency department, which totally blows for hospitals because a) ED staff aren't usually trained to deal with psych cases, and b) psych admits occupy profitable inpatient beds up to twice as long as average inpatient admits from the ED (like heart attacks, trauma/accidents, etc.).  Psych admits are unprofitable because most major mental illnesses, like schizophrenia, see their major onset during a patient's 20s, and the diseases leave the patient unable to hold down a job which ensures that they'll end up on Medicare/Medicaid or charity/self pay, which means you're not getting a lot of cashola for dealing with them.

Psychiatric/behavioral health treatment is also labor-intensive.  For an inpatient psych wing, you need a couple of psych nurses at all times, plus a couple of caseworkers, several therapists, group therapy leaders, psychiatrists (who, unlike psychologists, are able to prescribe meds, which is bullshit because psychologists get better training, really), specialists for different problems (depression, eating disorders, PTSD/trauma, PTSD/military, drug and alcohol addiction, etc)...and you need these people available on a 24-hour basis.  Most med-surg (your typical) inpatient hospital beds require much lower staff-per-patient ratios, and sometimes only about 1 or 2 nurses at night for 24-30 patients.  And labor in the US is what costs us so much.  Drugs are (relatively) cheap, but it costs a lot to pay a well-trained nurse to settle someone down and get a knife from the cafeteria out of their hands.

Again, I ask:  What.  The.  Fuck?

How can we not fund the care of a problem that costs us so much?  Think about the hidden costs of not caring for behavioral health issues: lost time from work, both in terms of the patient not getting paid and being out sick, plus the employer who loses effort and time and productivity from this illness; the worn-out staff that misdiagnoses other illnesses in the ED; the true emergency cases that have to wait and get even worse because the staff is handling out-of-control walk-ins that shouldn't be there.

And there's the other random lives that are touched when mental illness spills out and hurts others, like when a gunman storms a playground or restaurant.  Or the not-so-random lives, like when my uncle shot my dad and himself.

I should also add that building an inpatient psych wing costs.  You need special hardware that keeps people from hurting or isolating themselves, light fixtures and finishes (walls, paint, etc) that people can't beat up or hurt themselves on.  And if we as a culture would fund the care of the mentally ill--who often seem pretty normal most of the time--I could build the psych hospital that I was supposed to build over a year ago and why I started this blog in the first place, and it would give our office something to do and keep us from having to lay off yet more people.


ms. kitty said...

Amen, sister Pixie, I totally agree.

wilderness gina said...

Preachin ta da choir, Pix. Been dere done dat is not purty. Or cheap.