Nearly all of the roughly 1,000 beds in use at state-run psychiatric facilities are occupied and private providers said they’re also packed, as the strains of the coronavirus pandemic threaten to overwhelm the state’s mental health system.
Even as the worst of the sickness and death recedes from view, behavioral health professionals and mental health advocates warn a shortfall in treatment options could have devastating effects on those rubbed raw and reeling from the monthslong public health crisis.
As of Friday, 99% of the state-run psychiatric care beds were occupied, according to a Maryland Department of Health spokesperson. And data from the Maryland Health Care Commission shows the average bed occupancy rate among acute psychiatric care units in general hospitals rose from about 68% in both the second and third quarters of 2020 to almost 74% by the last quarter of the calendar year, the latest data available.
Meanwhile, some private behavioral health providers said they continue to see higher volumes of patients seeking treatment, with many qualifying for inpatient services.
“We’ve seen, in general, an uptick in people trying their best to get by and get through this. But that white-knuckling can only go so far,” said Dr. Todd Peters, vice president and chief medical officer at Sheppard Pratt, the state’s largest private, nonprofit psychiatric care provider. “We’re seeing heightened numbers across the board.”
Even as fewer people contract and die from the virus due to high rates of vaccination — and despite the gradual reopening of schools, gyms, offices and other pre-pandemic staples — mental health workers say they anticipate more than a year’s worth of stress, fear and anxiety to become more pronounced as the pandemic recedes.
Some expect long-term trauma to manifest as all corners of society begin to emphasize a “return to normal,” a concept many might find foreign now.
“It’s going to take a while to adjust again,” said Heather Lyons, a professor of psychology at Loyola University Maryland and a licensed psychologist at the Baltimore Therapy Group in Towson, which she runs. “We’re changed, in a way.
“Every therapist I know is completely full right now.”
Lyons said a patient at the practice needed to be hospitalized for a behavioral health crisis last week, and one of the counselors she works with struggled to find the person a bed.
“We were calling all over and everyone was saying they were full,” she said.
The five state-run psychiatric institutions — which typically house the most vulnerable patients, as well as those referred by the judicial or criminal justice systems — have about 1,629 beds among them. But only 1,026 are staffed, according to the state.
Bed capacity at those institutions usually stands at 95% to more than 100%, according to the state health care commission. Medical facilities tend to run most efficiently, at around 80% to 85% full.
“It’s hard to operate a facility at 99%,” said Elizabeth Sinclair Hancq, director of research for the Treatment Advocacy Center, a national nonprofit. “Without enough beds and community supports, the incentive structure of society is shifting people toward the criminal justice system.”
But it’s the wait at the state’s private psychiatric facilities and hospitals that has patient advocates, therapists and other behavioral health specialists especially worried. The private facilities like Sheppard Pratt have nearly 600 beds, though some are not staffed, while the hospitals have about 846 licensed beds.
Some, including Evelyn Burton, advocacy chair for the Maryland chapter of the Schizophrenia and Related Disorders Alliance of America, fear the shortage of bed capacity might lead to a rise in suicidal or life-threatening behaviors.
“We certainly need beds everywhere we can get them,” Burton said. “We were close to the breaking point, even before the pandemic.”
Nationally, the number of suicide deaths decreased in 2020, according to the U.S. Centers for Disease Control and Prevention. But the number of “unintentional injuries,” including drug and alcohol overdose deaths, jumped just over 10% to 192,176 in 2020 from 173,040 in 2019, data shows.
At the same time, mental health professionals and crisis counselors said requests for treatment have grown substantially over the course of the pandemic. Baltimore City’s crisis hotline, run by the Baltimore Crisis Response Inc., saw calls double last year in response to alarmingly high levels of depression and anxiety, and calls to suicide prevention lines in other cities spiked, too.
Dr. Theodore R. Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems, said a decadeslong shortfall of psychiatric bed capacity has posed problems around the country. In visits to hospitals across Maryland, Delbridge said providers often remark that it’s taking longer to transition patients out of emergency departments to the next, appropriate point of care.
“There’s concern that people who have lived with less social interaction are more vulnerable, and the availability of care for them has been modified,” he said.
Jenn Lynn, executive director of Upcounty Community Resources, a Montgomery County-based nonprofit for families with children with intellectual and development disabilities, said the people she counsels have reached the edge.
Many with disabilities have been stripped of their support systems and routines, with parents or caretakers left to try to provide the same level of care and stimulation. The community thrives off schedules, routine and predictability, she said, all of which evaporated last year.
“It’s shocking, some people were really scared,” Lynn said. “You can’t just turn that off; that’s where the trauma comes in.”
She now receives more calls from parents for help with behavioral crises than at any point during the pandemic, she said. Psychiatric space at private facilities and medical hospitals is scarce, especially for the disability community.
“It’s a crisis, and it’s not a new crisis,” she said. “But people needing [beds] are at a crisis pitch.”
Sheppard Pratt, which operates out of campuses in Towson and Ellicott City, saw demand for inpatient care dip in the early months of the pandemic as fears about the virus and uncertainty about its infectiousness kept people away from hospital settings. But gradually, those numbers rebounded and remain high still.
The psychiatric care provider has administered more than 500,000 virtual appointments since the start of the pandemic, Peters said, and has no plans to scale down that service.
“This has increased the ability to service people throughout the state,” he said of virtual care. “This allowed us to prevent people from going and waiting in emergency departments. There are some silver linings we don’t want to go away.”
Peters pointed to a disruption of in-person support groups and community services and programs, and prolonged social isolation, as factors in the high rates of bed occupancy.
“A lot of folks are coming in, in a bit of a dysregulated state, struggling quite significantly with depression, anxiety, mania or psychosis,” Peters said. “They’re impacted by all of this, because they’re out of their routine.”
Shanna Muschik, spokeswoman for Adventist Healthcare in Rockville, another private psychiatric care provider, said patients also are seeking mental health care because of conditions related to job loss, lapses in substance abuse, depression due to isolation or poor physical health, financial stress and domestic violence. The facility has seen bed occupancy levels return to near-2019 levels after a year of decline, she said.
Sheppard Pratt, which plans to open a new, state-of-the-art facility with more beds later this month in Elkridge, normally operates near full capacity. But as hospitals adopted an all-hands-on-deck attitude to combat the pandemic and minimized the number of patients that could stay in a room, the coronavirus “put a strain on an already strained system,” he said.
The pandemic also may have affected a population of people who never before interacted with the behavioral health care system.
Dr. Drew A. Pate, chief of psychiatry at LifeBridge Health, which operates Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital and Grace Medical Center under its service umbrella, said the medical system has seen steady numbers of patients seeking psychiatric care over the past 16 months. Many of them, he said, are new patients.
“These are people who traditionally would not have sought out mental illness treatment,” he said. “Maybe they’re experiencing stress over life or need skill-building.”
Pate said the occupancy rates at state and private centers typically fluctuate over time, with some periods busier or quieter than others. But the coronavirus pandemic highlighted the lack of funding directed to behavioral and public health services, he said.
“We need to dramatically think about resource allocation and services in the state system,” he said. “We need to have other ways to keep people safe and healthy, and to treat them.”
The National Suicide Prevention Lifeline’s toll-free number is 1-800-273-TALK(8255).