State Hospital Psychiatric National Bed Count Hits Historic Lows: Good or Bad?

A now slightly dated article published July 4, 2016 in many papers authored by Lateshia Beachum of the Washington Post that I came across in the Walla Walla Union Bulletin of Washington state recorded the magnitude of the cut backs nationally in public state hospital beds psychiatric beds. While this has long been known as a trend occurring over at least the last five decades, this article startled even this observer by how many beds have been cut by state governments in just the last several years. The article was entitled, “Psychiatric bed count hits record low in state hospitals.”

The first sentence of the article hints at two of the main themes: “The number of psychiatric beds in state hospital has dropped to a historic lows, and nearly half of the beds that are available are filled with patient from the criminal justice system.”

The author went on to detail results from a lengthy and reliable sounding several year study conducted by the Treatment Advocacy Center that in just over the last five years, from 2010 until 2016 in somewhat jarring fashion even to this long term observer just how many public psychiatric beds have been lost in this country.  She wrote that, “Researchers for the Treatment Advocacy Center, a national nonprofit organization, found states’ psychiatric bed total had fallen by 17 percent since 2010 — from 43,318 in 2010 to 37,559 this year. That has left just 11.7 beds per 100,000 people, far below the count in other developed countries.” In other posts, I have noted that the current averages for public psychiatric beds range from approximately 13 per 100,000 to 17 or so per 100,000 at a minimum.

The article also documented the now well known but long building crisis shared by state psychiatric hospitals across the country and the local [meaning county based],  and state correctional systems. The mentally ill, it bears repeating, have been “trans-institutionalized,” displaced from one setting to another, from hospital beds to jail cells by the thousands. And I quote: “The diversion of beds to criminal justice needs keeps increasing. Of states’ nearly 38,000 psychiatric beds early this year, 17,601 were only available for forensic cases, whether arrested suspects, individuals in local jails or state prison inmates. That was several thousand beds more than in 2010..”

The author also notes, only four states have increased their services to this population: “A few states, including California, Michigan and North Carolina, added publicly funded psychiatric beds over the past six years…” North Carolina, my state of practice, is in the process of finishing the final two new state hospital facilities to open next year which will add two new solely forensic units in the last two new hospitals to come on line and in service in 2017.

The article noted that, “….In nine [states], 16 state hospitals either shut down or were merged.” A startling example was that of “New York [which] saw the sharpest decline, shedding more than a third of the 4,958 beds it had available in 2010. It now has 3,217 [beds].” It is to be noted however that New York state has one of the most innovative and comprehensive community mental health resource rebuilding efforts in the country and its efforts are making very progressive and salutory differences.



Author: Frank

I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.

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