Mental health systems optimally include a care continuum to meet people’s needs in the most accessible, least restrictive environment. In a broad perspective, this continuum includes a range of services such as crisis services, accessible outpatient services, rehabilitation and recovery support services and inpatient psychiatric care. Access to inpatient psychiatric beds undergirds local mental health systems, providing essential services to help treat adults or young people who are experiencing mental illness, just like inpatient medical hospitalization serves the most acutely ill.
However, the number of psychiatric beds across private and public sectors has fluctuated and dropped significantly in the past 60 years. Today, amidst a mental health crisis, communities have no effective means to assess how many beds they need to meet demand in their population. Too often, psychiatric inpatient beds are not available when needed and people with mental illnesses end up boarding in emergency departments or being discharged prematurely. In worst-case scenarios, inaccessible treatment results in homelessness or involvement with the criminal justice system.
This report assesses the problem and proposes a new model for estimating the needs within a community. It provides a critical component to inform the decisions of community leaders and policymakers in services capacity development. It is separated into seven sections, including historical context, definitions, financing, population factors and special populations, community factors, children and adolescents, and the development of the model concept.
Sections of the Report
This section tracks the rise of psychiatric inpatient treatment in the United States, from the early days of family care, through its peak in 1955 at more than 500,000 beds, and the decline in the number of beds since then.
Section 2 - Definitions of Psychiatric Beds (.pdf)
An inpatient psychiatric hospital bed is a bed where an individual with mental illness receives psychiatrically supervised care 24/7. This section explores the different settings offering inpatient psychiatric beds and some sub-populations using them.
Section 3 - Financing of Psychiatric Beds (.pdf)
This section reviews barriers to inpatient care associated with current financing systems, offers policy recommendations, and highlights the potential opportunity for integrating psychiatric and primary medical care to reduce the costs and burden of comorbid disease.
Many barriers decrease access to psychiatric beds across populations, such as stigma, mental health workforce shortages, limited local resources, and insurance payor type. This section explores these barriers as well as those affecting specific sub-populations.
This section examines services and resources in community systems associated with hospital level of care. It focuses on data-supported interventions related to the entry and exit points of hospital-level care.
The Task Force worked on developing models for adults and for children/adolescents that might be used by communities and states to help estimate the number of beds necessary to meet the need for inpatient psychiatric care. This section includes a description of the model, an illustration of the model dashboard and results for the adult model developed for a hypothetical “Anytown, U.S.”
Section 7 - Child and Adolescent Psychiatric Beds (.pdf)
This section discusses the needs, services and resources for children and adolescents, often varying from those of adults. The section also reviews existing standards and guidelines for inpatient child and adolescent psychiatric care and standards for determining the appropriate intensity of care.
About This Report
The American Psychiatric Association (APA) Presidential Task Force on Assessment of Psychiatric Bed Needs in the United States was created in 2020 by APA's then-President Jeffrey Geller, M.D., M.P.H. and was led by APA Past President Anita Everett, M.D. The Task Force members included APA leaders, other mental health professionals, experts in child and adolescent psychiatry, and decision-analytic modelers. It was charged with reviewing the historical and current context of access to inpatient psychiatric care and undertook an effort to research and assess the current capacity of outpatient and inpatient psychiatric care in the U.S. This document represents the work of that Task Force.
This research report includes the work of several subgroups of the Task Force. It also presents an innovative predictive modeling tool that could ultimately be used to help communities throughout the U.S. determine the number of beds and other services required to assure that the needs of adults and children with mental illnesses are met. Despite the passage of national parity laws, individuals with mental illnesses continue to lack sufficient, effective, quality treatment in a healthcare system that is not on par with our general healthcare system.
At the heart of the Task Force’s efforts was a commitment to principles of recovery, including individual empowerment and person-centered services. The success of any comprehensive continuum of mental health care relies on optimized capacity of and access to inpatient psychiatric care. This report provides background, context, and a proposed model to help policymakers decide on appropriate resource allocation.
Task Force Members
- Anita Everett, M.D., Task Force Chair
- William Arroyo, M.D.
- Alan Axelson, M.D.
- Pratik Bahekar, M.B.B.S. (Fellow)
- Christopher Bellonci, M.D.
- Ramon Burgos, M.D., M.B.A.
- Gabrielle Carlson, M.D.
- Daniel Cho, M.D.
- Sandra DeJong, M.D.
- William Fisher, Ph.D.
- Christiana Fowlkes (Student)
- C. Freeman, M.D., M.B.A.
- Jeffrey Geller, M.D., M.P.H.
- Nitin Gogtay, M.D. (APA)
- Brian Hepburn, M.D.
- Christopher Hoffman, M.D.
- Julia Jacobs, M.D.
- Katherine Kennedy, M.D.
- Elizabeth La, Ph.D.
- Saul Levin, M.D., M.P.A. (APA)
- Kristen Hassmiller Lich, Ph.D.
- Ted Lutterman
- Noel Mazade, Ph.D.
- Michael Mensah, M.D., M.P.H. (Fellow)
- Laurence Miller, M.D.
- Ken Minkoff, M.D.
- Michael Naylor, M.D.
- Isabel Norian, M.D.
- Mark Olfson, M.D., M.P.H.
- Vivian Pender, M.D.
- Debra Pinals, M.D.
- Anita Rao, M.D. (Fellow)
- David Rettew, M.D.
- Barry Sarvet, M.D.
- Melanie Scharrer, M.D. (Fellow)
- Bruce Schwartz, M.D.
- Steve Sharfstein, M.D., M.P.A.
- Matthew Siegel, M.D.
- Raymond Smith, Ph.D.
- Paul Summergrad, M.D.
- Richard Summers, M.D.
- Ronald Szabat, J.D.
- Robert Trestman, M.D., Ph.D.