The shortage of psychiatric inpatient beds has become a major national issue, with the lack of availability identified as a major issue by policy makers, states, mental health families, academics, and popular media. Many reports regarding these shortages start with the major decline in inpatient capacity in state psychiatric hospitals—a decrease of over 500,000 beds since the 1950s. However, most analyses fail to include a comprehensive depiction of the total inpatient and other 24-hour mental health residential treatment capacity across the nation or to address the changing trends in the use of psychiatric inpatient services.
Beds available to provide 24-hour mental health treatment to individuals requiring this high level of restrictive and expensive treatment exist in a variety of settings, including specialized public and private psychiatric hospitals, psychiatric inpatient, and licensed residential treatment units in general hospitals and other organizations, non-residential treatment centers (non-RTCs) for children and adults (organizations that provide intensive 24-hour treatment services but that are not licensed as “inpatient” services), Veterans Affairs (VA) Medical Centers, Department of Defense Medical Centers, and psychiatric inpatient units within jails and prisons (these are beds not accessible to the general public). In addition, many general hospitals without special mental health units also provide inpatient treatment for individuals with mental illnesses (in “scatter beds”). Unfortunately, there is no single source of information that documents all psychiatric inpatient capacity across the various types of organizations that are providing these services.
This paper attempts to fill that need, combining information from multiple data sources to estimate the overall inpatient and other 24-hour inpatient capacity in the U.S. in 2014. Trends over the past 44 years in the 24-hour mental health treatment capacity of each setting are examined when comparable historical trend data are available.