KGH psychiatric beds in crisis

Lately I have had several patients who have gone through a frustrating and demoralizing experience when trying to gain admission to the psychiatric ward at Kelowna General Hospital. There appears to be a crisis when it comes to psychiatric hospital admission in our city.

Nearly always, people who seek hospitalization for a psychiatric problem are feeling acutely suicidal or out of control in some way. Going to the emergency room is almost always a last resort and a desperate attempt to get immediate help.

Unfortunately, the experience is all-too-often not very helpful. For one thing, there will nearly always be a long wait of at least several hours before seeing someone who can help. Most people also prefer to avoid admission because of the perceived stigma of a psychiatric hospital admission.

It seems that these days people are often told there are no beds available. If a hospital admission is considered necessary for the patient’s protection, he or she is often placed in a makeshift space such as a corridor with no privacy, no therapy and no protection. Many leave after a day or two when they realize there is nothing useful happening and that they would be just as well off at home. One individual I spoke with was put on a waiting list for admission when feeling suicidal. This person was not called for eight weeks – this is an intolerably long time to be left waiting in a suicidal condition.

So why don’t we have enough beds? In my opinion, the reason for bed shortages is that patients admitted to hospital for psychiatric problems are being kept much longer than used to be the case. Today the average length of psychiatric stay is about three times what it was 10 years ago. There is no evidence that longer admissions are associated with better outcomes or that patients today are more seriously ill than they were 10 years ago.

I believe the problem is that each psychiatrist makes his or her own decision about who needs admitting, how long they should be kept and what treatment should be administered on an in-patient basis. There is no consensus among the admitting psychiatrists on best practices in this regard. The same patient under the care of one psychiatrist could be admitted for six days while another may keep them six weeks. Each situation is governed by the individual philosophy and goals of each doctor.

Available beds for in-patient psychiatric treatment in a general hospital are based on a model of care that allows for crisis intervention, initiation of treatment and early discharge to outpatient community care and treatment plan.

This model can break down in various ways, but the biggest problem in psychiatry has always been a failure to get sufficient cooperation from all the different psychiatrists involved. Each tends to function autonomously and to aggressively guard independence.

In the meantime, patients who are admitted to a corridor or not at all are not getting appropriate care and are at risk for suicide.

More beds are not the answer. Better management is. This is a problem that can be solved with the available resources, but it will require leadership and cooperation.

 

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