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Large increase in bed capacity at North Carolina state psychiatric hospital needed to reduce average patient wait time below one day

RESEARCH TRIANGLE PARK, NC— Without increasing community-based psychiatric services, a large number of additional state psychiatric hospital beds would be needed to make a substantial impact on the average wait time of admission for people in crisis in North Carolina, according to a study co-authored by a researcher at RTI Health Solutions, a business unit of RTI International.

The study, published in Psychiatric Services, simulated the flow of patients through one of North Carolina's three state psychiatric hospitals to explore the supply-side, or hospital-based changes, that would be required to reduce patient wait times under three days, two days, and one day. 

Researchers found that reducing the wait below one day at the study hospital would require a nearly 165 percent increase in bed capacity.

"In the absence of more robust community-based services, this study sheds light on the substantial number of state psychiatric hospital beds that are needed to ensure timely access to care," said Elizabeth La, Ph.D., a senior research health economist at RTI Health Solutions, who conducted the study while at the UNC-Chapel Hill Gillings School of Global Public Health. 

A series of nine meetings with hospital stakeholders found that the total number of staffed beds at the study facility was fixed at 398, with the beds divided among multiple units serving patients with different needs. After looking into cost-neutral scenarios to accommodate patient needs, researchers found that most units were constantly at or near capacity, and shifting beds between units was not a viable solution for the larger wait time problem.

When patients with mental health needs cannot be properly treated through outpatient or general hospital care, state psychiatric hospitals act as the ultimate safety net. These state facilities are specifically designed and staffed to care for people with severe mental illness. Such hospitals can competently see patients through immediate crises as well as longer-term rehabilitation – unless those patients can't access care due to a lack of hospital beds.

"Understanding shortfalls in mental health systems and developing decision support tools to help stakeholders test alternate policy options in response to these shortfalls are critical first steps to ensuring that individuals experiencing psychiatric crises are able to access care in a timely manner," La said.

Although recent legislative proposals in North Carolina have called for the construction of a fourth state psychiatric hospital to increase system-wide capacity, authorizing legislation has not been enacted.

La and her co-authors acknowledge that the study region does not necessarily need this large number of additional beds added to the state hospital if functionally equivalent services can be provided in the community instead. Alternative solutions exist that could augment psychiatric hospital bed additions as part of a comprehensive resource optimization model. For example, psychiatric bed capacities could be increased in community general hospitals and freestanding crisis facilities. Another option may be to expand intensive outpatient services to reduce the total need for beds. 

Ultimately, the supply-side changes presented in the study provide only a partial answer to the growing problem of excessive wait times for psychiatric inpatient care. 

"The simulation model further could be used to explore demand-side solutions, providing a better understanding of the system as a whole and additional leverage points for improving care," La said.

The study, funded in part by a Gillings Innovation Lab grant, was co-authored by researchers at UNC-Chapel Hill, Duke University, North Carolina State University, University of Texas, and the Cecil G. Sheps Center for Health Services Research.