Facing millions of dollars in debt, a $130 million loss last year, and the same declining reimbursements as facilities nationwide, Boston’s Beth Israel Deaconess Medical Center announced last month that it will drastically cut some services while realigning others.

The reductions include the closing of all 60 inpatient psychiatric beds and significant scaling back of its outpatient psychiatric services. Moreover, the hospital will no longer allow Harvard Medical School students and psychiatry residents to train in its facilities. In addition, all clinical psychiatric research will have to be moved to other clinical sites.

"For years, this facility has been able to maintain high-quality inpatient psychiatric services," Mary Anne Badaracco, M.D., an assistant professor of psychiatry at Harvard Medical School and acting head of the department of psychiatry at Beth Israel Deaconess, told Psychiatric News. "And for years those services have lost significant amounts of money. The hospital simply cannot do that any longer."

Eighteen of the 60 beds were cut last month, with the remaining 42 being phased out by the summer of 2001. Outpatient services, according to Badaracco, are being reviewed; however, "we will continue to provide some level of outpatient psychiatric services."

"We anticipate that we will be able to continue the Harvard-Longwood psychiatry residency program, however, at alternative clinical sites," she continued. The hospital has been a partner with Boston’s Brigham and Women’s Hospital and the Massachusetts Mental Health Center in providing the clinical portion of Harvard’s psychiatry residency program. Badaracco said that Beth Israel Deaconess is discussing with Harvard the development of alternatives.

"We have really seen everyone pull together," Badaracco said, "including CareGroup [the corporate owner of the network of hospitals of which Beth Israel is the flagship facility], which has been in discussions with the Department of Mental Health, as well as Harvard, to develop alternatives for the inpatient beds, as well as the academic and research activities."

Badaracco blamed declining reimbursement for mental health services for the inpatient department’s demise. "Reimbursement simply does not cover the costs of doing psychiatric care in an academic, general hospital setting. On top of that, we have a significant number of patients who are either uninsured or underinsured."

Unfortunately, said Badaracco, the significance and the implications of the changes will be far reaching and potentially long lasting.

"It is a major public health problem because not only are we losing the ability to care for patients, but also we are also losing the ability to train the next generation of competent psychiatrists."