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UW Medical Center looks to close psychiatric inpatient unit

April 12, 2018 | By Manisha Jha

I was buzzed in and the door quickly locked as I shut it behind me. It was unexpectedly quiet in Seven North. There was a quote attributed to Maya Angelou hanging on the wall outside of a patient’s room. In a light blue text, it began:

“People will forget what you said … ”

The same light blue covered the front desk and the wall behind it. The desk held a monitor with several different surveillance camera views on it. The hallways from which patient rooms offshoot are painted off-white.

There are 10 beds in use in those rooms, but according to a nurse from the unit, it’s licensed for 16 — the unit was forced to cut the number about a year and a half ago. These beds typically serve nine voluntary patients per day and the unit admits around 430 patients per year, according to UW Medicine spokesperson Tina Mankowski.

The inpatient psychiatric unit at the University of Washington Medical Center (UWMC) on Montlake, also known as “Seven North,” may be losing the remaining beds soon.

According to an anonymous tip received by The Daily on April 5, “There have been ‘talks’ for some time that the inpatient beds will be closing with no plans for alternatives in the near future (at a time when there is already a severe shortage and increasing need).”

While 10 beds may not seem like a lot, UW students are often the patients occupying those beds.

“This will effect UW students,” the source warned.

“We have students here all the time,” explained one nurse in the clinic. “If you send those students to a regular psych ward, and they’re suicidal in the first place…” His voice trailed off, before he explained to me that those students could end up detained.

The potential closure of these beds is far from the beginning of neglect for psychiatric care in Washington state.

Until 2014, when the Washington State Supreme Court ruled it unlawful, patients experiencing a mental health emergency could be boarded in hospital emergency rooms without proper treatment for long periods of time.

“The patients wait on average three days — and in some cases months — in chaotic hospital emergency departments and ill-equipped medical rooms,” according to The Seattle Times. “They are frequently parked in hallways or bound to beds, usually given medication but otherwise no psychiatric care.”

This can aggravate psychiatric conditions even further.

“If you’re going to treat someone like an animal when they’re mentally ill and going through a crisis, of course they’re going to act up every once in awhile,” Matthew Jones, a patient boarded in an emergency room for six days, told The Seattle Times.

As of 2014, 27 of 39 counties in Washington had no involuntary treatment beds. Since boarding patients in emergency rooms is now largely illegal, these patients can be brought to larger treatment facilities with inpatient psychiatric beds in Seattle.

One of these facilities is Seven North.

“We fill beds from the entire state of Washington. I get calls from Bellingham to Olympia routinely,” said Seven North nurse Anita Stull to KUOW. The unit also gets patients from Alaska and Montana.

Even then, according to a report by Mental Health America, Washington ranks 48th in overall psychiatric care, combining one of the highest prevalences of mental health issues with some of the least accessible care in the country.

Another report, this one by the American College of Emergency Physicians, gave Washington’s emergency care environment a D+. As of 2014, Washington ranked third worst in the country for psychiatric beds, with 8.3 per 100,000.

In big red letters, the report reads, “The lack of resources and inpatient capacity for mental health patients is a major concern.”

48th out of 51 and a D+.

So when the need for this unit comes from all over the country and is part of a thin line of care for psychiatric patients in Washington, why would the hospital consider shuttering the unit?

In an email written to The Daily, Mankowski said the hospital is considering shutting down the UMWC inpatient psychiatric unit because, “The Centers for Medicare and Medicaid Services have new facility requirements for inpatient psychiatric units that will be costly to implement.”

This is a response to new ligature risk regulations. According to the Centers for Medicare and Medicaid Services (CMS), a ligature risk is anything a rope, cord, or other device that may be attached to with the intention of hanging or strangulation including coat hooks and hinges.

The American Psychiatric Association’s CEO and medical director Saul Levin, M.D., said the expenses to replace doors and other hospital features could result in the shutdown of psychiatric units.

“While, of course, we agree with the need to minimize the risk of suicide, we as psychiatrists know that the risk cannot be eliminated,” Levin said.

Psychiatrists from all over the country concur.

Philip Scurria, a psychiatrist from a small psychiatry ward in Mississippi, was told that doorknobs that were deemed a suicide risk would have to undergo an $800 replacement.

“Small units will be forced to close down because of this,” Scurria said.

Scurria may be right.

The APA and other medical organizations are looking to work with the CMS to review these regulations to provide input and evidence-based standards. However expensive it may get to keep up with new regulations, the need is there.

Because when it comes down to it, more than half of all college students have considered suicide.

Suicide is the second leading cause of death among college-aged students.

Mankowski assured The Daily in her statement that, “UW Medicine is committed to providing quality, compassionate, and safe care to our psychiatry and behavioral health patients.”

UW sanctions like the Healthy Husky Initiative and events like Fail Forward, displaying a commitment to the mental health of UW students.

But for college students, it’s a reality that someone you know has likely considered, attempted, or committed suicide. And there are countless other psychiatric issues all too prevalent among students, like bipolar disorder, substance abuse, and eating disorders. It’s clear that the need is there — that UW students, people from all over this state, and others — need available inpatient psychiatric beds.

These 10 beds are always in use. Harborview’s 65 to 70 beds always have a waiting list.

Now, more than ever, these beds are worth the cost. Their value is the value of patient lives.

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