1. Overview of Psychiatric Services Psych Workgroup – June 24, 2015

2. Definitions “Adult” means any individual aged 18 years or older. "Child/adolescent" means any individual less than 18 years of age. "Flex bed" means an existing adult psychiatric bed converted to a child/adolescent psychiatric bed in an existing child/adolescent psychiatric service to accommodate during peak periods and meet patient demand. 2

3. Psychiatric Beds and Occupancy - 2013 Data Source – 2013 CON Annual Survey Data 3 Acute Care Hospital-Based Freestanding Hospital Statewide Number of Facilities501060 Number of Adult Beds14096092018 Number of Child Beds67174241 Number of Flex Beds*028 Occupancy Rate (Adult & Child Combined) 66.98%80.00%71.45% *Approved but not yet operational in 2013.

4. Psychiatric Services Compliance Based on 2012 CON Annual Survey data Group-1:  Requires 60% occupancy for adult & 40% for child beds  19 hospitals of which 7 hospitals have child beds  1 facility not meeting occupancy for adult beds Group-2:  Requires 85% occupancy for adult & 75% for child beds  8 hospitals of which 1 hospital has child beds  8 facilities not meeting occupancy for adult beds  1 facility not meeting occupancy for child beds 4

5. Psychiatric Services Compliance Group-3:  Requires 85% occupancy for adult & 85% for child beds  4 hospitals  3 facilities not meeting occupancy for adult beds Group-4:  State Health Plan; no occupancy requirements  11 hospitals of which 1 hospital has child beds Group-5:  Grandfathered (prior to CON)  17 hospitals of which 1 hospital has child beds 5

6. Psychiatric Services Compliance Findings Acute shortage of psychiatrists in the State (e.g., high cost of hiring temporary contract employees) Retention of the current staff in the inpatient psychiatric setting Physical design of the psychiatric units  Private, semi-private rooms vs. 3 or 4-bed wards  Lack of appropriately set up bed (e.g., male/female patient)  Lack of capital for physical plant enhancements  Lack of secured/isolated units for high-acuity patients Internal operational procedures for certain Community Mental Health (CMH) and terms of contracts with psychiatric providers Different types of patient population and their treatment plans  Geriatric patients  Developmentally disabled, mentally impaired, autistic  Patients with acute medical conditions  High acuity (extreme violent behavior), one-to-one patient 6

7. Psychiatric Flex Beds Three freestanding psych hospitals approved for flex beds  Pine Rest Christian Mental Health – 12 beds  Forest View Psychiatric – 8 Beds (Operational 04/2014)  Henry Ford Kingswood – 10 Beds (Operational 05/2014) 7 Facility 1Facility 2 Number of Beds in the Flex Bed Unit810 Days the Flex Bed Unit Treated Child/Adolescent Patients98127 Patient Days of Care for Child/Adolescents Treated in Flex Beds 417605 Discharges for Child/Adolescents Treated in Flex Beds4283 Occupancy Rate for Flex Beds for Child/Adolescent Days53.2%47.6% Average Daily Census for Flex Beds for Child/Adolescent Days 4.34.8

8. Questions or Comments Tulika Bhattacharya, Manager Phone: 517-241-3344 E-mail: bhattacharyat@michigan.govbhattacharyat@michigan.gov Joette Laseur, Reviewer/Specialist:517-241-3342 laseurl@michigan.gov Andrea Moore, Compliance Analyst: 517-241-3345 moorea20@michigan.gov 8