Family and Caregiver Schizophrenia Discussion Forum

Bedless Psychiatry and A Recipe for Remaining Bedless

There is no better marker of the rickety psychiatric infrastructure in the USA than the lack of psychiatric beds. A close second is how those beds are utilized to basically run patients in an out to maximize hospital profits. It seems like I have said it a thousand times on this blog but I will say it again - hospitals make money by getting psychiatric patients out in advance of the diagnosis related group (DRG) time limit. These days that it is about 3-4 days. If management believes that the psychiatrist is not discharging people fast enough - they will turn up the heat on them to do so by using either a designated case manager or somebody who sits in team meetings and reports that psychiatrist to his or her superiors if the patients are not out by a maximum of about 6 days.

There are huge problems with that business approach to psychiatric care. The first is patient complexity. Severe psychiatric disorders place people at risk for significant medical problems and often psychiatric care cannot proceed until those medical problems are stabilized. During my career for example I had terminal cancer patients and patients with uncontrolled diabetes mellitus and hypertension admitted directly to my care because they had a major psychiatric disorder. Substance use disorders complicate at least half of the admissions and psychiatric care typically has to wait until a patient is detoxified from an intoxicant. Very ill patients with schizophrenia and mood disorders who received outpatient treatment cannot be treated and stabilized in 4-6 days. Specific problems like suicide risk and delirium often take many weeks of care. Although brief stays can be useful in the case of event or intoxicant related crises the length of stay on psychiatric units is basically an arbitrary number of days determined by bean counters rather than doctors. They do no reflect clinical reality.


Thanks for posting this! My husband is going thru “mental health court” right now for a crime he committed last year. He is diagnosed with schizoaffective disorder. In researching “mental health court”, I found some pretty disturbing facts regarding NJ. From 2010 to 2016, they went down a little over 400 beds in psychiatric hospitals. I have attached a website from the “Treatment Advocacy Center”, at the bottom it has an interactive map of the U.S. and you can see the number of mentally ill people along with the number of available beds in each state…disturbing to say the least!..