A report released in mid-September by the Forum and a team of national mental health consultants finds that for the immediate future, current adult psychiatric inpatient bed capacity in Milwaukee County is appropriate and should not be reduced further as part of mental health redesign efforts.  Over the longer term, however, additional reductions in bed capacity should be possible, though it will depend on the ability of public and private stakeholders to better coordinate service delivery and expand community-based services that decrease the need for hospitalization.

 

The report explores the demand for adult psychiatric inpatient beds and the capacity that should exist in Milwaukee County - a pair of highly relevant questions in light of ongoing efforts by the Milwaukee County Behavioral Health Division (BHD) to reduce reliance on inpatient and emergency mental health care and expand access to community-based care and treatment.  It was commissioned by BHD per a provision in the 2014 Milwaukee County budget. 

 

The lead researchers were the Massachusetts-based Human Services Research Institute and Technical Assistance Collaborative, while the Forum served as local researcher and coordinator.  The three organizations also teamed up on a comprehensive mental health redesign report released in October 2010, which has guided the County's redesign planning.  

 

The report's key recommendations include the following:

• Based on the current capacity and composition of the overall adult mental health system in Milwaukee, adult inpatient bed capacity should be in the range of 167 to 188 beds.  The report estimates that currently, among both public and private hospitals, there are approximately 201 adult beds in the system, of which roughly 150 beds are utilized.  The report's methodology, which considers admissions trends and hospital practices, estimates that there should be approximately 167 to 188 beds to meet the current utilization rate, which means there is enough total capacity to meet current demand.   However, the analysis also finds that a "tipping point" has been reached whereby additional near-term bed reductions could place an unacceptable strain on system capacity.

• 54 to 60 adult inpatient beds should be maintained to serve high-acuity and/or indigent patients and roughly 128 to 134 beds should be maintained to serve low- to moderate-acuity patients.  In 2013, private hospitals handled 85% of the behavioral health admissions in the county, while BHD handled the remaining 15% at its Mental Health Complex.  However, BHD tends to serve patients who have more complex presentations and longer lengths of stay, as well as those who lack insurance.  The data suggest that 54 to 60 beds is the needed capacity for high-acuity and/or indigent patients who historically have been served by BHD, while roughly 128 to 134 adult beds should be available for patients with low/moderate acuity who historically have been served in the private hospitals.  The report also emphasizes that the county and private hospitals should engage in regular joint planning to meet the inpatient needs of county residents. 

• BHD should expand community-based services that have been shown to promote recovery and decrease the need for hospitalization, and future decreases in bed capacity should be based on metrics that demonstrate a sustainable decrease in demand for inpatient beds.  The report praises BHD for its recent expansion of community-based services and finds that this expansion has reduced activity at BHD's hospital emergency room and helped to successfully accommodate reductions in bed capacity to date.  However, the increase has not been sufficient to further decrease bed capacity at this time.  Doing so will require further investment  to improve access to community-based services targeted to those most likely to utilize crisis and inpatient services.  Among these are efforts to increase mobile response activity or other interventions aimed to divert and reduce police interventions and emergency detentions; intensive and flexible services such as Assertive Community Treatment and supportive housing strategies; increased access to peer-delivered supports; and increased access to prescribers.

• The private hospitals should continue to increase their role in meeting the psychiatric inpatient needs of Milwaukee County residents, and BHD should collaborate with and assist the private hospitals to successfully treat individuals with complex situations and seamlessly facilitate their discharge back into the community.   The report suggests that much of the inpatient care provided at BHD can be provided by the private hospitals, especially if community-based services are increased and providers are equipped to work with consumers who have more challenging behaviors.  However, the County, and possibly the State, will need to consider the roles they might play in appropriately addressing concerns raised by private hospitals about finding appropriate community settings to which patients can be discharged.  

The report concludes by urging public and private stakeholders to consider "at what point it becomes economically inefficient for the County to continue to provide care at the Mental Health Complex."  To accommodate a reduced but continued need for high-acuity beds and the reimbursement issues discussed throughout the report, the report identifies four possible scenarios:

• BHD continues to operate a smaller number of high-acuity beds at the Mental Health Complex or in a smaller facility.
• BHD purchases high-acuity capacity at a private hospital or hospitals.
• Milwaukee County residents with high-acuity, longer term needs are referred to a State-operated hospital.
• BHD or the State operates a regionalized facility that serves Milwaukee County residents and residents from surrounding counties who otherwise would have been referred to a State hospital for longer term care. 

The full report can be accessed at: 
http://publicpolicyforum.org/research/analysis-adult-bed-capacity