Inpatient psychiatric care

Urgent Action Needed:

On September 8, 2011, Governor Quinn proposed the closure of three of the nine state psychiatric hospitals--Tinley Park, Singer and Chester Mental Health Centers.  This proposal contains no plan for serving persons with serious mental illnesses in alternative locations.  Linked below is the Summit's letter to Governor Quinn opposing this proposal.  

On October 5, 2011, the Commission on Government Forecasting and Accountabilty (COGFA) held a hearing in Rockford concerning the closure of Singer MHC.  Click here for information about that hearing including the written statement presented to COGFA by the Summit  On October 27, 2011 COGFA voted 8-3 to oppose the closure of Singer.

On October 12, 2001  COGFA held a hearing on the closure of Chester MHC.  On October 27, 2011, COGFA voted 11-0 to oppose the closure of Chester.  Click here to learn how each member voted.

On November1, 2011, COGFA will hold a hearing on the proposed closure of Tinley Park MHC.  Click here for the details of this meeting>

Please:

  • Call the Governor and urge him to reconsider this proposal
  • Call your state senator and state representative and urge them to oppose these closures.

Background

  • Since the 1950's Illinois has reduced the number of state operated inpatient psychiatric beds from 35,000 to 1,300 even though the state's population has almost doubled during this period.  Illinois has closed many facilities and downsized the remaining facilities.  Currently there are nine state-operated mental hospitals in Illinois.  Click here for statistics concerning the state inpatient facilities.
  • Approximately half of the 1,300 state operated beds are occupied by so-called "forensic" patients who have been involuntarily committed to state custody due to involvement in the criminal justice system following a finding of insanity of lack of fitness to stand trial. The largest number of forensic patients are confined at Chester MHC in Southern Illinois and Elgin MHC, 50 miles northwest of Chicago.
  • In the past fifteen years we have reduced the number of private psychiatric beds by more than 2,000 to approximately 3,500 beds.  This reduction has been caused, in part, by the fact that the reimbursement rate under Medicaid and other state funding programs does not cover the cost o inpatient care in private hospitals.
  • The need for beds has declined since the 1950's because
    • psychotropic medications have dramatically improved
    • we have evidence-based community mental health services such as assertive community treatment (ACT), supported housing, supported employement and peer support services
    • shortened lengths of stay in hospitals permits more persons to be served in the remaining beds.
  • Because we have fewer beds, those persons admitted to psychiatric hospitals have more acute symptoms.  This requires greater staffing levels.
  • Shorter lengths of staff also increase the need for more staff to handle the extra work involved with admissions and discharges. Click here for Illinois Issues article discussing staffing inpatient units
  • At least one study has found that Illinois has a severe bed shortage, arguing that we need 50 state- operated beds/per 100,000 persons.
  • Many years ago, Illinois decided to close the medical facilities it had maintained inside state operated facilities making it impossible for those facilities to treat persons with mental illnesses who have co-occurring non-psychiatric illnesses
  • Due to bed and staff shortages, persons with serious mental illnesses often must wait for hours in emergency department before they can be transferred to a state operated facility.  Outside of the Chicago area, patients must often travel more than 100 miles to get to the nearest state hospital.
  • Due to inadequate funding of both inpatient and outpatient care, persons with serious mental illnesses are frequently discharged from both public and private inpatient facilities without a plan for community care which is realistically expected to maintain those persons safely in the community and provide them with a realistic plan for recovery.
  • On August 9, 2011, the Centers for Medicare and Medicaid Services announced a Medicaid Emergency Psychiatric Demonstration project.  States may apply for federal matching funds to provide emergency psychiatric services in private, free-standing psychiatric hospitals.  Current federal law prohibits federal Medicaid funding in these facilities under the so-called "IMD" exclusion. Applications are due by October 14, 2011.

Mental Health Summit position on inpatient psychiatric care

  • A state-operated mental health facility should only be closed or downsized if the state has a comprensive plan for serving the persons served by that facility which has been developed in cooperation with community providers, consumers and advocates.
  • Inpatient mental health facilities must have sufficient numbers of well-trained and supervised staff to provide high quality care in a humane and safe environment.
  • Funds save by hospital closures or bed reductions should remain in the mental health system
  • Private hospitals are an important part of the mental health system of care.  Among other things, they can provide services closer to the consumer's home. Medicaid rates and other state funding programs must reflect the true cost of providing care, including comprehensive discharge planning.
  • Any plan to privatize state hospitals must include readily enforceable standards of care, including comprehensive discharge planning and outcome measures.
  • Inpatient services should only be used when needed.  They should be part of a comprehensive system of care for responding to psychiatric crisis. 

 

Research on improving discharge planning to reduce readmissions