Inpatient Program Cuts at Sam Health

Samaritan Health Services recently announced that it has reduced the number of beds and staff in its mental health inpatient unit in Corvallis, citing that many of the beds are going unused. Hospital officials claim that their new intensive outpatient program, called partial hospitalization, will better serve the mental health needs of the region, but some professionals in the mental health community are skeptical of this decision.

A recent census conducted by Sam Health indicated that the ward averages 11.7 patients despite the unit being currently outfitted for 16 patients, and 20 patients for most of 2018. The new outpatient program will allow patients to participate in therapy and additional prescribed activities during the day, before returning to their homes at night. Hospital officials have stated that such a program might further reduce the need for inpatient care.

A mental health professional for decades, local therapist Jana Svoboda suggests that the under-utilization of Sam Health’s inpatient ward is a much more nuanced issue than one of a simple lack of demand. 

County as Inpatient Gatekeeper
In Oregon, when a person is facing an active mental health crisis and requires inpatient treatment, they must first go to the ER to be processed and evaluated by hospital staff. After that, they need to wait for a mental health evaluator from the county to authorize them for inpatient care.

“They get there, they’re put in a gown, with their belongings placed behind a locked door. They are sitting on a table, maybe get their blood taken to check for substances, meet briefly with the emergency room doctor and wait for the county to show up,” explained Svoboda.  The cost for such visits can be significant and the wait lengthy. Svoboda has had patients wait several hours only to be sent home. She explained that when the evaluator arrives, they question the patient, asking if they can keep themselves safe for the time being, then asking them if they want to go home. “If you’ve been sitting naked in a cold room for seven hours, and are asked if you’d like to go home, you usually want to go home,” said Svoboda.

Svoboda said that she has put patients on months-long waiting lists for inpatient care, which generally defeats the purpose of a type of care that is meant to treat persons facing immediate mental health crises. She noted that many therapists in town report the same experience. “No therapist is even going to try to hospitalize a patient they aren’t really worried about. We know how hard it is to find a bed and how expensive and impacting hospitalization can be. But when someone is decompensating or suicidal, a stay can save their lives.”

A single night’s stay in the Sam Health psychiatric ward costs $1571, according to the hospital’s standard pricing guide. This number is for room and board, and does not include other associated costs, like medications, evaluations, and therapy. An extended stay in the ward can easily garner an uninsured patient a bill of tens of thousands of dollars. In Oregon, 10.3 percent of people with reported mental illnesses are not insured.

Partial Hospitalization
Samaritan Health’s new partial hospitalization program (PHP) is expected to begin in Fall of 2019, and both Benton County Health and hospital officials assert that the program will be effective in addressing the mental health needs of the county.

“This is an effective and less costly option than inpatient hospitalization,” said Benton County Health Administrator Mitch Anderson. “The structured program provides just what many patients need to help them transition back into community-based services.”

According to peer reviewed studies, PHPs aren’t meant to replace inpatient care in every case, but can be effective in supplementing it. According to a 2010 paper in Psychiatry by Dr. Imran Khawaja and Dr. Joseph Westermeyer titled “Providing Crisis-oriented and Recovery-based Treatment in Partial Hospitalization Programs,” PHP’s can alleviate some need for inpatient services.

“Although PHPs can be used in place of an inpatient admission in some cases, they are not a substitute for inpatient care for patients who are actively suicidal or homicidal, because the patients return home at night. Suicidal and homicidal patients require in-patient care, but PHPs can be used as an intermediate step to shorten an inpatient admission,” according to the report.

Svoboda contends that inpatient care may also be crucial for some patients that don’t necessarily pose an immediate threat to themselves or others.

“Sometimes the person may not be actively suicidal, but they are decompensating rapidly, and that time away from their life to stop, reset, and focus on getting their health back together is really critical, and it can prevent massive disruptions later in life,” explains Svoboda.

The Treatment Advocacy Center, a national non-profit organization that focuses on improving mental health care, released a report in 2016 that asserts that 50 inpatient beds per 100,000 people are needed to adequately serve the mental health needs of that population. In 2016, Oregon had 16.2 beds per 100,000 people on average, a 47 bed decrease from six years earlier in 2010. In Oregon, 24.9 percent of people with mental illnesses report an unmet need in treatment, the third highest percentage in the country. The most stunning Oregon mental health statistic might be the findings of a 2017 study by Mental Health America, which shows Oregon as the state with the highest rate of mental illness in the country.

Partial hospitalization programs have been implemented in many parts of the country with some success. This lower cost approach to mental health care may seem like an inevitable evolution, given the high cost of inpatient care in our ever-more costly for-profit healthcare system (it’s important to note that Sam Health is non-profit). The information we have paints a dire portrait of the state of mental health in Oregon, and some in the field point to an epidemic in the region that must be adequately addressed.

By Jay Sharpe