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Boarding

June 29, 2014

Is there no balm in Gilead, is there no physician there? Why then is there no recovery for the health of the daughter of my people?” (Jeremiah 8: 22).

By the time I left New York, every street corner was occupied by homeless individuals in rags, offering to wipe the windshields of passing motorists for small change. Men and women of all ages, in all weather, sat along the sidewalks, their few tattered belongings piled around them, as well-heeled shoppers hurried by.

Deinstitutionalization

New York was among the cities that undertook a mass psychiatric discharge in the ‘70s, in an effort to rescue patients from large facilities where neglect and abuse were not unknown.

Unfortunately, the attempt to transition psychiatric patients from in-patient to out-patient care was unsuccessful. The community mental health centers and halfway houses which would have made this a viable alternative were never established. NIMBY (“Not in My Backyard”) was one factor.

Shortage of Psychiatric Beds

The problem only deepened after that. Nationally, the number of publically funded psychiatric beds was reduced from approximately 400,000 – 420,000 in 1970 to an appalling 50,000 – 57,000 by 2006 [2][2A]. Since the Great Recession, states have cut mental health funding by an additional $5 billion or so [1].

As a result, the system has been overwhelmed. Patients in dire need of psychiatric hospitalization have been left to the mercies of homelessness, prisons, and hospital emergency rooms.

The retention of highly disturbed patients in emergency room settings – sometimes wandering the halls, while they wait for a bed – is so common today that a term has been coined for it: boarding [3]. Nationally, there are some 2.5 million emergency room visits by psychiatric patients each year [2A]. In Maryland, as an illustration, emergency rooms may see as many as a dozen psychiatric patients per day, and board as many as a dozen psychiatric patients for up to a week [3] [4].

Outreach

There are groups like Philadelphia’s Homeless Advocacy Project that actively reach out to homeless men and women. More often than not, however, the homeless lack any real understanding of their legal rights or the services available to them from government programs and non-profit organizations. This is attributable not only to their transcience, but the mental health issues from which many suffer.

The homeless are not a popular cause. There are few concerned for their welfare enough to act on those concerns, except the relatives of homeless individuals and psychiatric patients in danger of becoming homeless. There is, however, an opportunity here for Christians to exercise their faith.

We are meant to feed the hungry and clothe the naked, to take in the stranger (Isaiah 58: 7; Matthew 25: 34-46).  We may do that by handing out bologna sandwiches or volunteering at a soup kitchen.  We may do it by challenging our neighbors and our churches to become involved.

These actions are not likely to be popular either [5]. Nor are they likely to make the front page.  But that is not the point.

Conclusion

We are the wealthiest nation on earth, yet cannot manage to find homes (and necessary psychiatric treatment) for some of our most vulnerable citizens. On a deeper level, we are the people of God, with the Good News of Salvation to share. That is the true balm of Gilead, a cure as vital to us as to the homeless.

If the problem of boarding does ignite a fire in us for the needy and for God, it will have served a greater purpose than those attempting to cope with the critical shortage of psychiatric beds can know.

[1] PBS Newshour, “New Series Reveals ‘The Cost of Not Caring’ for Americans with Mental Illness,” with Judy Woodruff and guest Liz Szabo of USA Today, 5/23/14, http://www.pbs.org/newshour/bb/new-series-reveals-cost-caring-americans-mental-illness/ .

[2] US House of Representatives, Energy & Commerce Committee, 3/26/14, http://energycommerce.house.gov/hearing/where-have-all-patients-gone-examining-psychiatric-bed-shortage .

[2A] Health Affairs, “Hospital Psychiatry for the Twenty-first Century” by Stephen Sharfstein and Faith Dickerson, Vol. 33, No. 6, http://content.healthaffairs.org/content/28/3/685.full.

[3] National Center for Biotechnology Information (NCBI), US National Library of Medicine, National Institutes of Health, PubMed Commons, “A plan to reduce emergency room ‘boarding’ of psychiatric patients” by Vidhya Alakeson, Nalini Pande, and Michael Ludwig, September 2010, http://www.ncbi.nlm.nih.gov/pubmed/20820019.

[4] Currently, Medicaid does not cover emergency psychiatric services for working-age adults in institutions with over sixteen beds. As a practical matter, this means that hospitals go unreimbursed for boarding, though it utilizes scarce emergency room resources and increases wait times for all patients. The Patient Protection and Affordable Care Act of 2010 (“Obamacare”) provides for a pilot project to address boarding. This pilot would allow hospitals to receive Medicaid reimbursement for emergency psychiatric care. The law, also, provides for an option which would federally fund 90% of community mental health care for states electing to pursue that option.

[5] NBC News, “Florida Couple Cleared of All Fines for Feeding Homeless People” by Bill Briggs, http://www.nbcnews.com/news/us-news/florida-couple-cleared-all-fines-feeding-homeless-people-n111561.

READERS CAN FIND MY VIEWS ON ABUSE AND ABUSE-RELATED ISSUES AT ANNA WALDHERR A Voice Reclaimed, Surviving Child Abuse  http://www.avoicereclaimed.com

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