As more Americans seek mental health care in inpatient psychiatric facilities, families face a troubling lack of accessible information about the safety and quality of these institutions. Unlike nursing homes or general hospitals, many psychiatric hospitals are subject to less robust public reporting and transparency requirements, making it difficult for patients to make informed choices during some of their most vulnerable moments.
Momentum may be building for change, in part, due to the work of Morgan Shields, an assistant professor in the School of Public Health at Washington University in St. Louis. Shields has spent a decade researching the hidden harms in psychiatric settings and advocating for better federal monitoring. Her work is now helping shape national policy.
“Patients and families in every state ought to be able to access user-friendly information regarding inpatient psychiatric facilities,” Grassley wrote. “There’s more to be done, including expanding critical measures in the reporting program.”
On June 9, U.S. Sen. Chuck Grassley (R-Iowa) sent a letter to the Centers for Medicare and Medicaid Services (CMS), urging the agency to overhaul how it tracks and shares data from psychiatric hospitals. Citing several of Shields’ peer-reviewed studies, Grassley pressed CMS to strengthen the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program and to ensure that its planned IPF star rating system includes meaningful, transparent measures that reflect real patient risks. This rating system is still in the planning phase, and CMS has not announced a launch date. CMS also is enhancing information available on its Care Compare website.
The IPF star ratings, modeled after similar CMS systems for nursing homes and hospitals, are intended to help consumers compare psychiatric facilities based on standardized quality metrics. The ratings are designed to give a quick, easy-to-understand snapshot of care quality. But critics say the psychiatric ratings don’t fully reflect critical safety concerns that can occur in mental health settings.
“As patients in inpatient psychiatric settings are uniquely vulnerable to harm,” Grassley wrote, “the IPF star ratings should include measures related to patient safety events, including physical assaults, sexual assaults, suicides, unexpected deaths, injuries and elopements (unauthorized departures) that occurred during the course of hospitalization.”
Shields, whose research was cited in Grassley’s June letter and an earlier February letter to CMS, said the experience has been unexpectedly validating.
“This is exciting,” she said. “He is calling for what I’ve been writing about for 10 years. It is affirming and motivating. You never know who is reading our work.”
Among the studies Grassley cited were Shields’ analyses of complaint patterns, restraint and seclusion use, and quality differences among public, nonprofit and for-profit psychiatric hospitals. In one 2023 study published in the Journal of Patient Experience, Shields and co-author Mara Hollander highlighted patterns of serious incidents in Massachusetts psychiatric facilities over a 10-year span. Another 2017 paper in Psychiatric Services compared outcomes across types of hospital ownership, showing significant disparities in quality.
Deb Parker is senior news director of public health in WashU Marketing & Communications.