In the two decades since the “To Err is Human” report spotlighted the dangers of patient harm, incremental progress has been made across the healthcare industry to make patient care safer.
Safer, that is, except for when it comes to behavioral health, according to a new study published in Health Affairs.
Case in point: The Protection and Advocacy for Individuals with Mental Illness Program, which is run by the Substance Abuse and Mental Health Services Administration (SAMHSA), served nearly 14,000 people nationwide in hospitals in 2014 for claims like sexual assault, inappropriate use of restraints and overmedication.
In a single state—Massachusetts—there were 10 reports of physical abuse in inpatient psychiatric hospitals in 2014 and twice as many reported cases in 2015. There were also 20 reports of human rights violations—which includes complaints like being denied a second opinion or receiving incomplete information about a diagnosis—in 2014, and 15 reports of restraint or seclusion use.
Researchers at Brandeis University and Rush University said the major drivers of the problem are a number of market failings in inpatient psychiatric care, such as lack of regulatory oversight and a lack of research and focus on ways providers can prevent harm in such settings, lead study author Morgan Shields, a Ph.D. student at Brandeis, said this week at a briefing on the Health Affairs issue. She likened the psychiatric care industry to a “black box.”
“Inpatient psychiatric care is on the sidelines of improving patient safety, despite the glaring need,” Shields said.
Access to data is a major barrier in promoting research. To obtain even just the Massachusetts data, the study team had to submit a Freedom of Information Act (FOIA) request to the state’s Department of Health, she said.
Another concern for the researchers is the growing number of psychiatric hospitals run by private companies instead of not-for-profit providers. By 2016, 30,000 inpatient psychiatric beds were operated by for-profit providers, compared to about 35,000 each by nonprofit providers and the government.
The number of for-profit beds increased from about 21,000 in 2014, while nonprofit beds remained flat and government beds declined substantially from more than 50,000.
For-profit psychiatric hospitals are more likely to exploit the market failures identified in the study, such as families’ lack of regular access to patients and limited patient choice, Shields said.
The researchers offered several policy changes that could lead to safer psychiatric care. For one, payment structures must promote high-quality, patient-centered care. At present, payers often miss the mark in advocating for behavioral health patients, the study found.
Trauma-informed practices must also be built into provider training and the culture at these psychiatric facilities. Such an approach can mitigate both psychological and physical harm for these patients, Shields said.
“Patient safety within inpatient psychiatry needs considerable attention and should be the next frontier for health policy,” the researchers said.