The Senate Finance Committee, led by Sen. Ron Wyden (D-Ore.), recently released a report and held a hearing on youth residential treatment facilities. The report details some heartbreaking circumstances, including abuse of patients. These incidents are unacceptable, and residential treatment facilities must do better.
The report and hearing shed light on important public policy issues that must be addressed with skill, accuracy, and alacrity. But we must go beyond personal emotions and anecdotes and hear what the experts have to offer.
As one of the committee’s witnesses, Elizabeth Manley of the University of Connecticut School of Social Work noted that “[t]hese residential treatment facilities can have a significant benefit to the young person and their family.”
Youth patients receive residential treatment when they have significant challenges, including tendencies to harm themselves, exhibit violence towards others, or have other serious behavioral problems. These facilities offer around-the-clock care and treatment in a therapeutic setting that address their social and emotional needs. This level of care is unavailable in traditional healthcare facilities.
With residential treatment, many patients mitigate or overcome mental health challenges, substance use and behavioral disorders, and other disabilities. But Sen. Wyden proposes cutting their funding, which would reduce access to vital care.
Sen. Wyden said in the hearing he wants “to work in a bipartisan way to shut off the fire hose of federal funding for these facilities” in response to the awful incidents cited in the report.
Cutting funding may be an understandable initial reaction to hearing about incidents of abuse, but it would exacerbate health disparities by decreasing access to care for families and children who most need residential treatment.
Limiting Medicaid for residential treatment would simply make it a luxury service reserved for well-off families. Youth from all backgrounds struggle with behavioral health. Making treatment less affordable for families would be unwise for achieving better health outcomes for youth.
Sen. Wyden also said in the hearing that treatment facilities are trying “to turn big profits” from care. One of the witnesses said behavioral healthcare providers have “a high profit margin.”
What they may not realize, however, is that behavioral health generates small profit margins compared to other health fields. In fact, this likely contributes to the shortage of behavioral health treatment options.
Hospitals are increasingly striking up partnerships with behavioral health companies because they want to dedicate their limited space and beds to more profitable care. But someone tuning into the hearing would find that fact hard to believe.
The report also details understaffing. Unfortunately, it’s true that the behavioral health field lacks sufficient professionals. The Health Resources & Services Administration says the U.S. has the need for over 129,000 behavioral health workers, but only 111,000 or so are available. The gap is projected to grow dramatically over the coming years.
Though nearly every state has required staffing ratios for residential facilities, we need to support our nation’s healthcare workers so we can retain these professionals and build a strong recruiting pipeline of future workers who can meet patients’ needs.
The report shows how difficult it is to treat behavioral health. Many of the patients in residential treatment are there because other treatment options are inadequate and not suitable for patients who may be a danger to themselves or others.
The committee’s report is important for highlighting necessary improvements, but it ignores the vital role these facilities play. With a full understanding of residential treatment facilities, policymakers and treatment providers can work together to ensure the best use of public funds and, even more importantly, the best possible health outcomes for patients.
Peter J. Pitts, a former FDA Associate Commissioner, is President of the Center for Medicine in the Public Interest and a Visiting Professor at the University of Paris School of Medicine.
