Psychiatric hospitals on the rebound in Tarrant [Fort Worth Star-Telegram]

Jan. 12--More than a decade ago, psychiatric hospitals in the Fort Worth area went through a wrenching collapse after insurers and employers tightened their payments in response to abuses in admissions and billing.

The number of beds available for mental patients who needed round-the-clock hospitalization plunged from nearly 900 in 1993 to fewer than 200 by 2000. But in recent years, inpatient psychiatric beds have slowly bounced back, and Tarrant County appears to be on the edge of a jump in capacity.

Last week, Sundance Behavioral Healthcare broke ground for a 60-bed expansion, which will more than double the capacity of its Sundance Hospital in southwest Arlington, which opened in 2010. The $5.5 million project is expected to open in the fall.

Two other organizations have filed plans with the state to build inpatient psychiatric facilities in Fort Worth, but neither is yet under way. Even with Sundance Behavioral's growth, inpatient psychiatric beds in Tarrant County will number just over 400, fewer than half the 2000 count.

"There were too many beds in the 1990s, and then it went to the other extreme," said Dr. Raju Indukuri, one of three psychiatrists who own Sundance. "The pendulum is swinging back, hopefully to the middle."

The rebound is apparently driven by the region's population growth, a lessening of societal stigma attached to mental healthcare and federal legislation affecting insurance benefits. The Mental Health Parity and Addiction Equity Act of 2008 required large group plans to equalize mental-health and substance-abuse benefits by 2010 with those applied to medical and surgical treatments. And the Affordable Care Act is expected to extend benefits to more Americans when additional provisions take effect Jan. 1, 2014, including the expansion of Medicaid and the mandate for Americans to buy health insurance or face penalties.

For example, Universal Health Services, by far the nation's largest operator of psychiatric hospitals, is getting ready should a surge in demand materialize. Chief Financial Officer Steve Filton told investment analysts last week that "we'll begin to add capacity more aggressively" if that occurs.

Universal Health acquired a big competitor, Ascend Health Corp., last year for $517 million. That gave it 187 behavioral health facilities, including Millwood Hospital in Arlington and facilities in DeSoto, Dallas, Denton and Lewisville.

But Indukuri said Sundance's expansion plans "are based on our current demand, not extra insurance patients."

Vice President Randy Kaniecki said Sundance's hospital is often full, as are other Tarrant County facilities.

"It's not unusual for us to have a waiting list," he said.

Ramona Osburn, senior director at Texas Health Springwood Hospital in Bedford, said the facility went from 50 to 70 beds about a year ago, adding a unit aimed at seniors. She said Springwood now has a daily census of about 65.

That growth has come even as Springwood opened five outpatient centers in five years, she said. Each center sees about 50 patients a day, she said.

J.R. Labbe, vice president of communications and community affairs for JPS Health Network, said its JPS Trinity Springs Pavilion, which has 96 beds, is running at about 90 percent capacity. JPS has grown by 42 beds since 2007.

JPS has no plans for more inpatient beds, but as part of a plan for handling Medicaid patients it proposes a number of service expansions in cooperation with other providers in the area.

Nashville-based Haven Behavioral Healthcare has filed plans for an inpatient psychiatric hospital in Fort Worth'sMedical District. The privately held company has said it expects to open eight more facilities in 2012 and 2013.

A Haven Behavioral representative said last week that the company has not started work on the Fort Worth facility.

Another organization, Mesa Springs Llc., has filed to build an inpatient psychiatric hospital in far southwest Fort Worth. Representatives of the company, which lists an Austin address, could not be reached for more details.

Countering the trend of adding beds is Baylor All Saints Medical Center at Fort Worth, which closed its 24-bed inpatient psychiatric unit in October 2010. Spokeswoman Susan Hall said the hospital still provides outpatient treatment.

In all, Tarrant County has 355 inpatient psychiatric beds, including 11 that Cook Children's Medical Center operates.

Although that's fewer than half the beds in 1993, there's really no reason Tarrant County needs 900 beds, even given its rapid population growth, observers say.

For example, inpatient psychiatric hospitals in that era became notorious for easy admissions and long stays. That simply doesn't happen today.

"In the '90s, you saw these 30-day stays," Indukuri said. "Now it's seven days" to treat and stabilize an acutely ill patient who might have been suicidal or threatening others. That might be followed by outpatient treatment, perhaps several hours a day in a facility before going home at night, then transitioning to community-based care.

"Inpatient beds are for the most acutely ill patients. Twenty or 30 years ago, everybody was sent to a bed. Now the idea is to have the least restrictive environment," said Dr. Laurence Miller, a Little Rock psychiatrist who sits on the American Psychiatric Association'sCouncil on Healthcare Systems and Financing. "At most hospitals, it's a very short stay."

It's better to think of inpatient beds as "just one, somewhat small piece" of mental healthcare, Miller said. For example, community-based services, like crisis intervention, school-based programs and educational programs "may help keep people out of inpatient beds. I think you'll see an expansion of those services."

Patsy Thomas, president of Mental Health Connection of Tarrant County, agreed with Miller's perspective.

"One of the best things for psychiatric care in Tarrant County is mobile crisis services," which include a 24-hour hotline that can send a team if needed.

"There are definitely times inpatient beds are needed to stabilize a person in crisis," Thomas said. "But in Tarrant County, because we didn't have those inpatient beds for so long, we had to get real creative designing a way to deliver services."

Labbe said the proposals for handling Medicaid patients likewise "are focused on decreasing inpatient need and length of stay" and instead look "for ways to serve in the community."

Those projects include expanded hours at JPS behavioral services, partial hospitalization and intensive outpatient programs, and mental-health screening.

Jim Fuquay, (817) 390-7552

Twitter: @jimfuquay

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