A Simple Solution to the Bed Shortage? Unfortunately, Jail.

While researching our book, Committed at the American Psychiatric Association's annual meeting, I went to a session on involuntary hospitalization on the Salt River Pima-Maricopa Indian Community. According to Dr. Monica Taylor-Desir, a psychiatrist in the community, there are no psychiatric beds on the reservation. A patient who needs an involuntary hospitalization is held in the local jail until an evaluation can be done and a bed becomes available at a nearby state hospital. Often, the process takes weeks.

I was appalled. These are patients, not criminals, and she noted that nuisance charges could be filed to justify detaining the patient in the facility. So I was not completely surprised—just equally appalled—to read reporter Michael Anderson's recent article in the Rapid City Journal. Anderson noted that his city has a shortage of psychiatric beds in the local hospital. Sometimes the unit fills, and traditionally, patients with psychiatric disorders are hospitalized on medical units until an appropriate bed becomes available. It's not a bad solution, but recently the hospital has determined that the medical units are not able to safely treat these patients, and they can be disruptive to the rest of the unit. One might think there would be a way of designating part of a medical unit to take less acute psychiatric patients, and hiring appropriate staff. Instead, the hospital has decided that unless a patient is also suffering from an acute medical illness, overflow patients will stay at the local jail. But these are not criminals. Can you imagine going to an Emergency Department after a suicide attempt and being sent to jail?

We talk (all too much) about legislation to force people to get help. Psychiatric treatment decreases suffering, it lets people lead fuller lives, and it prevents homelessness and incarceration. We hear about people who don't appreciate that they have a mental illness, and so they refuse treatment. We hear about programs to decrease stigma, so the vulnerable will seek the care they need. But how do you do this when asking for help means you could be placed in a jail cell—the exact thing that psychiatric care is meant to prevent? Our kindness and humanity seems to have been locked out of the treatment process.