Reduced State Psychiatric Hospital Capacity and Increased Restraint Use: A Case Series From a Community Psychiatric Hospital

Severe mental illness (SMI) is a significant and persistent public health challenge in the United States. In recent decades, shifts in mental health policy regarding deinstitutionalization have altered how long-term psychiatric care is delivered, often leaving individuals with some of the gravest forms of SMI without sustained support. This paper presents a case series of three patients, advocating for a limited increase in the number of state-funded hospitals in the Commonwealth of Virginia. These patients were repeatedly admitted for treatment-resistant schizophrenia. Once stabilized in an acute care psychiatric hospital, they would be discharged to home and often stop treatment, leading to readmission. After multiple readmissions, it was concluded by clinicians that they may be better suited for a long-term psychiatric facility in order to achieve sustained remission from schizophrenia. However, several long-term psychiatric hospitals had significantly decreased their capacity. This led to higher acuity in an acute care hospital, as observed by a greater number of restraints being utilized, leading to difficulties in providing adequate care for all at the hospital. This case series underscores the importance of a more personalized approach to healthcare, as opposed to the large, poorly regulated institutions of the past in the United States that often subjected patients to inhumane treatment.