RESEARCH WEEKLY: Reframing the Asylums as a Necessary, Lifesaving Component
Psychiatric beds are an important component of the continuum of psychiatric care, Dr. Steve Sharfstein argues at his January 8th, 2020 Wulfson Memorial Psychiatry Grand Rounds presentation in New York City.
Rather than considered as a ‘last-resort’ or ‘failure of the system,’ Dr. Sharfstein proposes that acute inpatient care should be reframed as lifesaving and a necessary component of care. As evidence, he speaks about two of his former patients who had a suicidal plan; one who tragically died and the other who did not, in part due to their immediate access to an acute psychiatric bed.
The Wulfson Memorial Psychiatry Grand Rounds at Weil Cornell Medical is an annual presentation given to physicians, medical residents, and students to honor Harris Wulfson, a man who died by suicide after escaping the psychiatric hospital.
Suicide and psychiatric beds
Dr. Sharfstein starts his talk by presenting work by himself and colleagues on the relationship between suicide and access to psychiatric beds. Over the past 30 years, the United States has seen a large increase in the rate of death by suicide in addition to a critical decline in the availability of psychiatric beds. When examining trends of both over time, the graphs mirror each other. Dr. Sharfstein posits the question of this relationship to the audience, “correlation or causation?”
Although the question is in part a rhetorical one, he goes on to give evidence on how there are too few psychiatric beds available and that there is a critical role of acute patient care in supporting recovery. Goals of acute inpatient care include crisis stabilization and safety, comprehensive diagnostic formulation/reformulation, biological and psychological assessment, respite, family engagement, and comprehensive discharge planning, he says.
“Perhaps correlation or causation is the wrong question,” Dr. Sharfstein says. “The right question may be, ‘how many suicides could be averted if we had more beds?’”
A full copy of the presentation slides can be found here.
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Dr. Steve S. Sharfstein, served as the President and CEO of the Sheppard Pratt Health System for 25 years before retiring in 2016. Prior to his work in Maryland, Dr. Sharfstein served as the Director of Mental Health Service Programs at the National Institute of Mental Health and worked with First Lady Rosalynn Carter on the Mental Health Systems Act in 1980. Dr. Sharfstein is a member of the Treatment Advocacy Center Psychiatric Advisory Board.
