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COVID-19 spreading quickly through psychiatric hospitals: Reduction of population a must

As our nation faces the historic challenge of COVID-19, the public health risks of confining people in close quarters in jails and prisons have received significant attention. However, much less attention has been paid to the public health risks of confining people in psychiatric hospitals. That must change. We must reduce the population of psychiatric hospitals for the safety and lives of patients, staff, and their families.

Patients in psychiatric facilities, like those incarcerated, live in close quarters and many have physical health conditions. In fact, people with serious mental illness have more medical issues than the population at large and are at greater risk of serious complications from COVID-19.

COVID-19 has already spread quickly through several psychiatric hospitals across the country. New Jersey’s four state psychiatric hospitals have had a total of 240 confirmed cases and five fatalitiesFour patients at St. Elizabeth’s psychiatric hospital in Washington, D.C. have already died from COVID-19 complications and half are in quarantine.

Psychiatric hospitals, like correctional facilities, are potential incubators for the virus. Yet little information is available about the steps that states, localities, and the hospitals themselves are taking to mitigate the danger — including threats to their own staff.

Staff and patients at psychiatric hospitals often do not have access to personal protective equipment. In New Jersey, Ancora employees were discouraged from wearing masks “because it would scare patients.

Washington Federation of State Employees (WFSE), a union representing more than 2,000 employees at Western State Hospital in Washington state criticized the hospital’s response to COVID-19 as “bordering on negligence.” One employee said the hospital was a “death trap waiting to happen.” 

We must reduce the number of people confined in psychiatric hospitals by only using inpatient treatment when absolutely necessary.” At the same time, discharges should be accelerated, and the federal government, states, and localities must increase their support of community providers of outpatient mental health treatment to facilitate this decrease in the psychiatric inpatient population.

The good news is that the federal government has taken some steps forward by already increasing the share it pays for most Medicaid funded services, including community services, and lifting restrictions on telemedicine. 

However, more is needed. Community providers, already strapped before the pandemic, need increased funding to manage this crisis as well as greater access to technology and personal protective equipment.

Lastly, we must also increase access to housing. We need to make use of a variety of housing options, including housing subsidies newly available through the CARES Act, vacant hotel rooms and college dorms, trailers including those provided by the Federal Emergency Management Agency (FEMA), and even recreational vehicles. 

We are facing many challenges as a result of the COVID-19 pandemic, including the challenge of mitigating the pandemic’s effects on mental health. We cannot ignore the public health risks of confining people in psychiatric hospitals. Just as we are reducing the number of people at close quarters in jails and prisons, we must also reduce the number of people in psychiatric hospitals.

Ira Burnim is the Legal Director at the Judge David L. Bazelon Center for Mental Health Law. He is recognized for his expertise in legal and policy matters related to the Americans with Disabilities Act (ADA), Medicaid, community mental health care, and children’s issues. The Judge David L. Bazelon Center for Mental Health Law advocates for the civil rights, full inclusion, and equality of children and adults with mental disabilities.

Tags Community mental health service Mental health Mental health in the United States Positive psychology Psychiatric diagnosis Psychiatric hospital Psychiatry

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