Mental disorders and addiction have unleashed a rising tide of patients with behavioral problems in central Ohio emergency departments. But the help they seek continues to be in short supply. The problem was underscored this week by a new report that found that U.S. prisons now house 10 times as many seriously mentally ill people as state psychiatric hospitals do.

Mental disorders and addiction have unleashed a rising tide of patients with behavioral problems in central Ohio emergency departments. But the help they seek continues to be in short supply.

The problem was underscored this week by a new report that found that U.S. prisons now house 10 times as many seriously mentally ill people as state psychiatric hospitals do.

The Dispatch reported that nearly 10,000 inmates are on the mental-health caseload in Ohio's prisons, with 4,356 of them seriously mentally ill. Fewer than 1,000 patients are staying in six state psychiatric hospitals.

In Franklin County hospitals, waits of more than 24 hours for psychiatric beds are common and exceed the national average, though they're a big improvement over the four to five days some local patients endured as they sought inpatient placements a few years ago.

One key reason: The region lags most of Ohio in the number of psychiatric hospital beds for its growing population, according to the state Department of Mental Health and Addiction Services.

For every 100,000 people, the Columbus area has 23.5 private and public adult psychiatric beds compared with 37.2 in northeastern Ohio and 31.3 in the Cincinnati area.

And many mental-health patients have insurance that cuts off payment and ends their hospital visits before they are stabilized, said Terry Russell, the executive director of the National Alliance on Mental Illness of Ohio.

"We still very much have a broken system of behavioral health-services delivery," said Dr. John Campo, the chairman of the psychiatry department at Ohio State University.

But the central Ohio hospital community has made some significant strides in addressing these unmet needs, said Campo and other local mental-health officials. Chief among the changes is the Franklin County Mental Health Bed Board, a system through which patients who wait the longest for placement get the next available psychiatric bed, regardless of where it is.

"The wait times are actually being managed much more effectively," said David Royer, the chief executive of the Alcohol, Drug and Mental Health Board of Franklin County. "The situation has definitely stabilized."

The region's stock of psychiatric beds also has rebounded somewhat, mostly as a result of for-profit psychiatric hospitals' setting up or expanding in the region.

The 72-bed Dublin Springs psychiatric hospital opened in August 2012, and the Ohio Hospital for Psychiatry plans to grow from 90 to 130 beds next year as part of a $10 million expansion. But those hospitals by law cannot provide psychiatric services to most nonelderly adults on Medicaid.

"Another 40 beds will be useful to the community," said Roxanne Jividen, market chief executive officer in Ohio and Indiana for Acadia Healthcare, which operates the Ohio Hospital for Psychiatry. "It may not be enough."

State officials also acknowledged the limited supply of beds in central Ohio by reducing the size of the area served by the state's Twin Valley psychiatric hospital in Columbus, which typically operates at or near capacity.

Starting late last year, patients in Madison, Clark and Greene counties who need an inpatient stay at a state psychiatric hospital are sent to Cincinnati. Those counties had accounted for 1.4 percent of Twin Valley's admissions between July and September 2013.

Among local nonprofit hospitals, only Ohio State University's Harding Hospital recently has added inpatient beds. The addition of five boosted its total adult psychiatric-inpatient bed count to 53.

In the past two years, the university also has doubled its number of psychiatric and behavioral-health faculty members and has tripled its number of advanced-practice behavioral-health nurses.

A year ago, the university began using telemedicine for psychiatry evaluations at Ohio State University East Hospital, where patients previously had little access to psychiatrists, said Dr. Natalie Lester, medical director of psychiatric emergency services.

And the university added an eight-bed observation unit for psychiatric patients in October.

"What we're seeing is that more and more patients who are presenting in crisis are able to be stabilized and discharged home (without inpatient admission) than ever before," Campo said.

Franklin County's 24-hour mental-health and substance-abuse crisis-intervention center - NetCare - has had similar success in heading off the need for inpatient psychiatric stays, said its medical director, Dr. Pablo Hernandez.

About 70 percent of patients referred to NetCare are discharged within 30 hours, he said.

"If we had 100 beds for every 100,000 people, a lot of people would end up in the hospital," Hernandez said. "Do they really need to be in a hospital?"

A lack of professional psychiatric staff members has placed limits on the region's inpatient psychiatric bed count, but financial considerations also are a factor. Such services often are not profitable for hospitals.

Ohio State's inpatient psychiatric unit at Harding Hospital is projected to lose more than $2 million this year, and the shortfall is expected to widen to more than $4 million in its next fiscal year as the hospital grows its commitment to those facing mental disorders and addiction, Campo said.

OhioHealth said it has taken steps to make its psychiatric services more robust. While it has not added to its 39 beds at Riverside Methodist Hospital, it added a "partial hospital" program a year ago, said Dr. Dallas Erdmann, the hospital's medical director for behavioral health.

Through the program, patients spend five hours a day, five days a week for several weeks undergoing counseling, seeing psychiatrists and learning to manage their medications, all in a bid to stabilize their lives and avoid the need for future hospital stays.

The hospital also is linking the patients it discharges with community mental-health centers, Erdmann said.

Two years ago, Mount Carmel Health System partnered with Southeast Inc. to provide outpatient psychiatric services through its mobile medical coach, said Brian Pearson, director of community outreach.

While an expansion of the state's Twin Valley hospital isn't planned, the expansion of Medicaid in Ohio should mean hundreds of millions of dollars in additional funding each year to help Ohioans dealing with mental illness or addiction.

Gov. John Kasich's mid-biennium budget review also includes more than $30 million to expand crisis and housing services, which mental-health advocates say is key.

"There is increasing movement to re-medicalize behavioral-health treatment," said Dr. Mark Hurst, medical director for the state Department of Mental Health and Addiction Services. "We really have been segregated from the rest of health care for several generations."

bsutherly@dispatch.com

@BenSutherly