Slate

Tough economic times affect everyone. Even, apparently, the ability to look at data in a rational and logical manner.

When your data tell you that your psychiatric hospital bed capacity is hovering around 97 percent, many people would consider that a sign that perhaps more psychiatric hospital beds are needed.

But in Massachusetts, apparently the reverse is true — at least, that is, when you start looking at ways to cut the budget. The Boston Globe has the story:

A state commission has proposed speeding up the closure of Westborough State Hospital and a slate of other measures that would cut about 120 psychiatric beds at a time when the mental health system is already under significant strain.

The proposal is in response to a $13 million budget deficit at the state Department of Mental Health and would reduce its 788 adult continuing-care psychiatric beds – those that provide inpatient mental health services and are operating at 97 percent capacity. Yet a commission member said the impact would be partially offset by 200 people being discharged from hospitals into community programs.

Not only will speeding up the closure of a psychiatric hospital already slated to close save money, but it will actually improve care to patients needing psychiatric hospitalization. How so? Well, according to the state’s logic, we’ll just discharge those “extra” patients into outpatient or community care settings sooner. Like, right now.

But wouldn’t you already have done so if there were people who could be better served in a less restrictive environment? The state appears to be saying, “We admit, we’re not presently providing the best possible, least restrictive psychiatric care for patients today.”

Or, more cynically, they’re saying that only as a matter of convenience to save some money.

The state has already cut 100 social workers from a system that could ill-afford such human services cuts. Now this state commission has recommended further cuts to services in the hopes that the community services will somehow magically make up for the lack of psychiatric hospital beds.

What happens when a community has fewer psychiatric beds than the population needs? Patients partake of emergency medicine services in ERs. Are ERs well-equipped to address a patient’s mental health needs? Most are not. And guess how much an ER bed costs? Significantly more than a psychiatric hospital bed does. A perfect example of not seeing the forest for the trees.

The commission also suggested that funding for the additional community treatment services could be paid for this year by Obama’s economic stimulus package. That’s great for this year, but what happens next year, when nobody’s looking and the hospital beds have already been cut? The state will cut back the community services, since there won’t be any federal stimulus money to partake of every year for years to come. And once again, the most vulnerable people in Massachusetts will be forsaken by their government.

I’m all for cutting back unnecessary psychiatric hospital services, especially for less-restrictive and more open-ended outpatient services. I already believe this should be the norm — that a psychiatric hospitalization is usually an avenue of last resort. And it would make absolute sense if these hospitals were running at 40 or 50 percent of their capacity.

But when your hospitals are running at 97 percent capacity and you have only a short-sighted plan on how to make up for the cut of 15 percent of that capacity, I don’t feel like it’s necessarily been well-thought through with an eye for “What’s best for patients?,” not, “What’s best for meeting this budget deficit?”

What a strange world we live in where politics — not science or scientific data — dictates the best treatments and care for an individual in need.

Read the full article: State commission proposes speeding closure of Westborough State Hospital