“It’s mentally and physically exhausting. And when you have a large number of cases, it can get dangerous. Are you dispensing the wrong medication because you’re overwhelmed? Do you forget to lock a door because you are overwhelmed?”
Fischer said he couldn’t blame the state.
“We can’t afford to lose psychiatric beds, but there are really safety issues,” he said, adding “it wouldn’t be difficult for some patients to overwhelm staff if there weren’t enough staff.”
Michigan has a mix of private and public mental health facilities that provide outpatient and inpatient care. State hospitals typically provide about a quarter of Michigan’s inpatient psychiatric beds, but play an outsized role in treating the most difficult cases.
There are five state mental health centers in Michigan, including four for adults. The daily number of residents fluctuates depending on the needs of the patients and the availability of the staff:
- Kalamazoo Psychiatric Hospital was treating an average of 103 patients per day in August, the latest available figures from MDHHS. That’s down from 151 people in April. During this time, 50 beds in the hospital were taken off the grid.
- Walter Reuther Psychiatric Hospital in Westland, west of Detroit, treated 148 people a day in August, up from 167 patients in April. Twenty of its beds were taken offline.
- The Caro Center east of Saginaw, as well as the saline-based Center for Forensic Psychiatry, which provides screening and treatment for suspects, had no bed closures.
The Hawthorn Center in Northville, which treats children, saw about 39 patients a day in August, compared to 50 in April. The state has closed seven beds in Hawthorn. But officials said the closures were temporary and due to construction, not staff shortages. When work is complete next year, Hawthorn expects to significantly expand its bed capacity to accommodate 78 to 80 children in emergency situations.
More money but a tough sell
The Kalamazoo and Westland bed closures are another blow to Michigan’s flimsy, state-run behavioral health system. Waiting times for admission to psychiatric hospitals for patients with complex, sometimes severe, mental illness can range from days to weeks or longer.
In a three-part series last year, Bridge Michigan chronicled the desperation of families whose children were “cared for” in hospital emergency rooms while they waited for one of the state’s shortage of psychiatric beds.
The cuts come as the state invests more in psychiatric hospital care. The budget for operating the state’s five residential hospitals for people with serious mental illness or intellectual or developmental disabilities increased to $347 million next year, up from $44 million four years ago, according to the state Budget Office .
But state health officials express some of the same frustrations as private companies in their failed efforts to fill vacancies.
According to online job listings on Indeed.com, Reuther Hospital is seeking help in the hospitality industry, where jobs start at $14 and $15 an hour. A job on the state’s website for a “home help” in Kalamazoo starts at $19, while an activity therapy assistant job starts at $21 an hour. Elsewhere, there are job postings for residential nursing assistants (starting at $19 an hour) as well as higher-paying clinical social workers, nurses, and a psychiatrist.
Mellos said applications for entry-level positions were up slightly, but the state faced a “hiring desert” for most of the summer.
Direct care workers with a high school diploma “can make more money driving Lyft, Uber and DoorDash” while having more flexibility in when they want to work, Mellos said.
trickle down problems
Government hospitals play a unique and critical role in the larger mental health field, traditionally providing treatment for patients with the most chronic, complex psychiatric problems, which may require months of residency followed by intensive follow-up care in local community mental health facilities.
A reduction in government beds increases demand for beds in private hospitals and facilities, which generally offer shorter stays, with patients returning home after their crisis has stabilized.
However, privately owned hospitals and clinics are also faced with staff and bed shortages.
Michigan currently has 2,301 privately operated adult psychiatric beds in its inventory, of which the state said more than 170 beds are short of what is needed.
Since October 2020, staff shortages at Michigan’s hospitals have closed 1,400 inpatient acute care beds across the state, according to a Michigan Health & Hospital Association report sent to lawmakers Thursday.
That includes hospital beds in psychiatric wards, although an exact figure was not immediately available, MHA spokesman John Karasinski said.
“We’re working with the state to figure out how to get through this crisis,” Laura Appel, MHA’s executive vice president of government relations and public policy, said of the bed shortage. “At the same time, I cannot blame (state officials) for their challenges.”