Clarifications to the 2008 Mental Health Parity and Addiction Equity Act 2008 are also an additional component that could drive demand for more psychiatric care. Late last year, put more muscle behind the law, requiring doctors and insurers to treat mental illness the same as physical illness. This means services can get reimbursed easier, which could help meet the demand for psychiatric care, but it's too early to tell what the effect will be, says Zeller.
"It's a mixed bag," he says. "I don't think it's been established long enough yet that we have really been able to see if it is going to have a major effect; though even if you're getting a real solid reimbursement rate for psychiatric beds. If you've got a limited number of beds and you're not getting enough treatment in the emergency outpatient setting, it doesn't matter how good the reimbursement is unless you have a place for somebody to go."
And so starts the vicious and sometimes violent circle of psychiatric patients in the ED. After getting them out, where do they go? There are residential facilities, community homes, [and] psychiatric hospitals, but these are not the places where psych patients often end up, says Whitters.
"The pendulum has swung, and our society has determined that it's not okay to institutionalize people, but it is okay to put them in jail."