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resulting in missed care, intentional or unintentional discrimination by organizations and government agencies, dwindling services, and reluctance to seek treatment. "What really catches my heart is that these patients are the most misunderstood patients that we have," said Rucker, a behavioral health RN in the emergency department at Jackson Park Hospital in Chicago since 1996. "These are patients with illnesses. They are not completely aware of what's going on. We need to treat them like any other patient. They need help." T he number of facilities that provide inpatient psychiatric care has been dwindling for decades. As the American Psychiatric Association (APA) noted in its May 2022 report, "The Psychia- tric Bed Crisis in the US," in 1955, there were 337 inpatient beds per 100,000 people. By 2014, that figure had plummeted 91 percent to 29.7 beds per 100,000. The report also states that the "number of children with severe and acute mental health needs is beyond cur- rent treatment capacities." The APA report attributes the drop in psychiatric beds to "federal policy changes, the development of antipsychotic drugs, and the rise of managed care, among other factors." The report also notes that while "overall spending on mental health treatment has steadily increased," the percentage of mental health care spending on inpa- tient care dropped nearly 36 percent from 1986 to 2014 and "there are numerous barriers to inpatient care associated with current financing systems." The closure of behavioral health units is devastating for commu- nities. Recently, the BHUs at Florida Medical Center in Lauderdale Lakes and Palmetto General Hospital in Hialeah, Fla. shut down in August and September, respectively. The closures represent Steward Health Care's common practice of putting profits over patients and shuttering what they deem "unprofitable" units. "I have worked in these units for 16 years and the need for psychi- atric services has never been this high," says Gladys Emekekwue, an RN who worked in Florida Medical Center's BHU. "There are no other options for our patients. They don't have transportation and are in no condition to travel long distances to seek care. Our patients will definitely be at great risk of suicide and self-harm." One twisted outcome of the loss of available beds is that today, the largest mental health facilities in the nation are jails, according to the continuing education class on America's mental health crisis that National Nurses United offered last spring. (The class will be offered again, check the schedule on NNU's website.) In the class, nurses learn stark, eye-opening facts, such as, if you have a mental illness, you are more likely to be incarcerated than hospitalized and that as many as one-third of the unhoused population has a serious mental illness. Susan Beekman, RN at Mission Hospital Copestone, the BHU at HCA's Mission Hospital in Asheville, N.C., notes that Dorothea Dix Hospital, the state's first psychiatric hospital, closed its doors in 2012, a huge loss for people who needed long-term care. Founded in 1856 in the state capital of Raleigh, about 250 miles east of Ashe- ville, its namesake was a pioneer in advocating for humane care for the mentally ill in the 19th century. Dix would no doubt be pro- foundly disappointed and appalled that 135 years after her death, the number of U.S. mental health facilities and services have decreased, not increased. Today, Beekman's facility has three adult inpatient behavioral health units and one for children and adolescents. She cares for adult patients from all across the Blue Ridge Mountains in the west- ern part of the state. Beekman speculates that a lot of people that were at Dorothea Dix Hospital "came to the mountains." Rucker's adult patients in Chicago get admitted to her facility's BHU while children and adolescents get transferred to other hospi- tals or if they are wards of the state, they may get stuck in the ER because the Department of Children and Family Services can't find a place for them. Rucker also comes across behavioral health patients in their 30s who had been living in nursing homes, their only option for care. They left the facility and realized they could not survive on the streets. To return to the nursing home, they need to be admitted to the hospital for an assessment. T he Covid-19 pandemic exacerbated the nation's mental health crisis beyond measure. Our NNU nurse members working in behavioral health units see the most severe cases, where patients' conditions have deteriorated past self management. The pandemic completely disrupted people's lives, livelihoods, and support networks. Weiss said "a lot of the patients have been sicker because of increased substance abuse, domestic violence, and food insecurity." While some units, like the operating room or post anesthesia care, became ghost towns when Covid first hit, his unit has been full of patients since Covid began. "People had trouble getting medications," said Weiss. "They also had their own death and loss. They haven't been able to have access to a psychiatrist. Some clinics don't want to accept new patients, the wait times are too long, or they are considering therapy and there is no therapist available for them. So then the patients are even worse than they were prior to Covid." At hospitals, the scarcity of BHU beds only got worse due to the J U LY | A U G U S T | S E P T E M B E R 2 0 2 2 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 19 Laura Dixon, RN, latency and adolescent unit, Sutter Center for Psychiatry, Sacramento, Calif.