Psychiatric System Crunch Worsens

Waits for Beds Increasingly Exceed Md.'s Legal Maximum

Because of a shortage of beds at Maryland psychiatric hospitals, a growing number of patients, including many who are involuntarily committed, are spending days in emergency rooms, often in violation of a state law that mandates that they be placed at a comprehensive care facility within 30 hours of commitment, heath-care officials and patient advocates say.

In some cases, they say, this has forced doctors to release patients regardless of their mental state, sometimes only to have them involuntarily committed again with no guarantee that they will be placed promptly at a psychiatric facility.

The bottleneck of mental health patients in emergency rooms has been in the making for years, as the number of psychiatric beds in public and private hospitals has decreased. The long delays are worrisome to health care officials and patient advocates because they say the waits often worsen patients' conditions and overburden already busy emergency departments.

"This is a national problem," said Patricia Petralia, vice president and chief operating officer at Potomac Ridge Behavioral Health Center in Rockville. "They're not receiving active treatment."

State officials acknowledge the problem, but they say cases of patients who are not referred to inpatient psychiatric facilities within 30 hours are not widespread. They say they are trying to address the issue by quickening the referral process and monitoring patients more closely to make sure they get access to the type of treatment they need.

"The number of beds available has not kept up with the demand," said Brian Hepburn, executive director of the Maryland Mental Hygiene Administration. "Anytime you have someone released on a technicality means they're not getting their needs met."

Elsewhere in the region, Virginia has no time limit prescribed by state law, but it often faces problems placing involuntarily committed patients into facilities.

"We hear anecdotal complaints of people waiting in emergency rooms for extended periods of time," said James Reinhard, commissioner of the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services.

In contrast, the District's St. Elizabeths Hospital has 420 beds for psychiatric patients, more than enough to meet demand in the city. "We're not experiencing a crunch," said Linda Grant, spokeswoman for the D.C. Department of Mental Health. "Traditionally, we have not had a problem with placement."

The number of beds at Maryland state psychiatric hospitals declined by 72 percent between 1982 and 2005, according to a report released last month by the Maryland Health Care Commission. The drop from 4,390 to 1,235 beds during that period came as three hospitals closed and others downsized. The number of beds at private licensed psychiatric hospitals fell by 37 percent during that period, dropping from 830 to 519.

The number at state and private psychiatric hospitals in Virginia also has dropped sharply in the past 30 years. The reasons for the decreases, health experts say, include the deinstitutionalization of many patients and the difficulty of making psychiatric hospitals financially solvent.

Neither Maryland officials nor the patient advocates could provide specific numbers of people affected by the delays caused by the shortage of beds. But they agree the delays are increasing.