Hurricane Irene wiped out Vermont’s last-standing psychiatric facility in 2011, making the state the only one in the country that now goes without any government-operated psychiatric beds. Bloomberg’s Tom Moroney looks at what that means on the ground:

The number of patients held in Vermont emergency rooms for want of a bed has spiked. This year through April, 49 mentally ill patients were held for as long as two days, up from 18 in the same period last year, according to the state Department of Mental Health.

When the state hospital was open, the private Fletcher Allen facility typically turned away about 15 mentally-ill patients a month, said [Robert] Pierattini, the chief psychiatrist [at the private hospital in Burlington]. Just after the closing, that number hit 40 a month. It peaked at 130 early this year, and has since returned to 40 or so this spring, he said.

Some patients end up handcuffed to hospital beds, Moroney reports, for as long as two days as they wait for a transfer to a psychiatric facility. The changes aren’t unique to Vermont; During the recession, 3,144 psychiatric beds were eliminated across the country in 2009. Those funding decisions have consequences: One 2009 study that looked at the elimination of psychiatric beds during the 1980s in California found the elimination of one public bed per 100,000 people was associated with an increase of 0.25 suicide each year.