A task force of the Minnesota Psychiatric Society identified the following reasons as contributing to the shortage of inpatient psychiatric beds in their state:
• Inadequate funding. The percentage of health care insurance premiums in Minnesota that reimburse mental health services decreased 16 percent between 1998 and 2002 and now represents 2.6 percent of the total health premium (excluding prescription drugs). Medicare reimbursement for psychiatric treatment is limited to 50 percent of the fee schedule, instead of the 80 percent paid for other medical care. Psychiatrists are paid 10 percent to 40 percent less than primary care physicians for equivalent outpatient work in typical contracts with Minnesota insurance companies.
• Increasing public awareness and demand. Patients, celebrities, and legislators are speaking out on the toll mental illness has taken on their lives. Popular magazines are covering mental illness.
• Lack of discharge placement options. Delays occur in arranging discharge placements to regional treatment centers, nursing homes, group homes, and residential treatment units. Access to social-service case-management services is limited.
• Lack of coordination between those providing inpatient and outpatient care and between payers and providers of care.
• Onerous working conditions. Items mentioned include increased workload and new laws and regulations, such as those concerning seclusion and restraint.
• Closing of state facilities and outpatient clinics.
• Lack of coordination of outpatient and inpatient services for people who have a dual diagnosis of mental illness and substance abuse.
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