By Mauricio Sirvent
As CEO of a busy hospital early in my healthcare career, I saw the country’s struggle to provide adequate mental health resources first hand. Not only did I witness the struggle—I had to manage it from the financial perspective, first as the CFO at one of South Florida’s busiest hospitals and then from the operations perspective, as its CEO. It was only later in my career that I understood how telePsychiatry helps hospitals alleviate psychiatrist shortages.
Managing a hospital’s resources to care for patients with mental health issues is one of the most difficult challenges a hospital leader can face. The difficulty is in the persistent national shortage of psychiatrists, which impacts both hospitals that have an inpatient behavioral health unit, and those without one.
telePsychiatry for Hospitals without Inpatient Behavioral Health Units
In the case of my former facility, a busy urban hospital just off the Florida turnpike in Miami, we did not have an inpatient behavioral health unit during the time I was there (although I did start the hospital towards the process of applying to the state for the addition of an inpatient behavioral health unit.) This meant that patients who came in through the emergency room had to be placed in nearby facilities. Monday through Thursday, this was difficult enough, as the psych facilities nearby were already overcrowded, and we were competing with nearby hospitals to get patients in. Heading into the weekend, Fridays began the difficult task of securing placement, let alone Saturday and Sunday, which was nearly impossible.
Hospitals without an inpatient psych unit, like what I experienced at the time, are continually dealing with psych patients who must stay in the ER until appropriate placement can be found in the catchment area. Until that happens, they must be cared for in the ER, increasing the chances of having to board patients in hallways, and leading to a drain on clinical resources which could be used to care for other patients.
At my former hospital, it was common to have an average length of stay of around four hours for most patients. But for a psych patient who was waiting for placement, it wouldn’t be unusual to have them in the ER for up to 24 hours. The math on that is pretty clear: one psych patient takes about the same time and space as six other patients normally would, and usually without the ability to bill for that time.
According to data from a national survey on mental health capacity, about half the nation’s general acute care hospitals remain as my former facility was then: lacking an inpatient psych unit. In the West, only about 44 percent of general acute care hospitals have the ability to care for 24-hour inpatient psychiatry patients, though in the Northeast that number is 66 percent, according to the survey.
Without an inpatient behavioral health unit, the case for telePsychiatry is crystal clear. A telePsychiatry consultant that is used on a fractionalized basis by the hospital can be called upon to get a determination quickly and accurately as to whether a patient can be discharged, or will need to be admitted or found placement somewhere. Emergency physicians are typically very cautious about discharging psych patients—that’s why it’s important to have a telePsychiatry consult available.
If patients come, often brought by the police, with an involuntary commitment, again a telePsychiatrist can help reverse the involuntary commitment, if that’s appropriate, so that the hospital can discharge the patients as quickly as is safely possible.
telePsychiatry for Hospitals with Inpatient Psych Units
telePsychiatry can also play a crucial role in supporting hospitals that do have inpatient psych units. And research shows that need is only going to grow. Even before COVID-19, the National Alliance on Mental Illness found that 19 percent of adults reported some kind of mental illness, an increase of 1.5 million people over the previous year.
The report found that youth mental health is also worsening, from 9.2% of young people reporting major depression up to 9.7%. From January to September 2020, the number of people seeking help for anxiety and depression “skyrocketed,” according to the report, increasing 93% from the same period a year earlier. Across every metric you can measure, the numbers are grim.
A telePsychiatry program can help support hospitals as they deal with this surge. For those with inpatient psych units, telePsychiatry can provide evening coverage or weekend coverage, helping to make sure your attending physicians avoid burnout. The supplementary coverage provided by telePsychiatry can help handle the ebbs and flows in volume, again on a fractionalized basis. A telemedicine platform, like SOC’s Telemed IQ, can also be used by health systems to enable their own clinicians to support multiple locations.
Whether in the emergency room setting or the inpatient setting, telePsychiatry must be part of the solution to the country’s psychiatrist shortage, and to the increasing pressure on hospitals and health systems to care for these patients.
Mauricio Sirvent is the Executive Vice President, Care Delivery – Neurology & Psychiatry. Sirvent has over 25 years of expertise leading and advising health care organizations with an emphasis on operational efficiencies. In his current role, he is focused on the strategic growth and alignment of the neurology and psychiatry service lines of Access TeleCare. This involves working with Access TeleCare partner hospitals to improve the quality of care for patients in an effective and streamlined manner while working internally to improve the planning and execution of key care-delivery processes, resource utilization, staff schedules, and quality outcome measurement.