Report finds US deficit of nearly 100,000 inpatient beds; result is increased homelessness, emergency room overcrowding, and use of jails and prisons as de-facto psychiatric hospitals
A March 2008 report by the Treatment Advocacy Center reveals that for every 20 public psychiatric beds that existed in the US in 1955, only one such bed existed in 2005.
According to data cited in The Shortage of Hospital Beds for Mentally Ill Persons, in 1955 there were 340 public psychiatric beds available per 100,000 U.S. citizens. By 2005, the number plummeted to a staggering 17 beds per 100,000 persons. Mississippi was found to have the most beds available in 2005 (49.7 per 100,000 people), while Nevada (5.1) and Arizona (5.9) had the least. For the complete report, state-by-state ranking of beds lost, and list of recommendations click here.
“The results of this report are dire and the failure to provide care for the most seriously mentally ill individuals is disgraceful,” said lead author, Dr. E. Fuller Torrey, president of the Treatment Advocacy Center. “Our communities are paying a high price for our failure to treat those with severe and persistent mental illness, and those not receiving treatment are suffering severely. In addition, untreated persons with severe mental illnesses have become major problems in our homeless shelters, jails, public parks, public libraries, and emergency rooms and are responsible for at least 5 percent of all homicides.”
To determine a minimum number of beds needed, a consensus of experts involved in the study looked at specific criteria such as number of individuals who need hospitalization, length of hospital stay, and current state and federal financing structures. They also were asked to assume that effective community based services and assisted outpatient treatment programs are available in all 50 states. Using these criteria, the panel concluded that 50 public psychiatric beds per 100,000 individuals is the absolute minimum number required to meet current needs. Eight states still don’t have assisted outpatient treatment and many states are in need of additional community mental health services, making 50 public psychiatric beds per 100,000 people a minimum requirement.
“This report confirms what many in the mental health field already know – too many people with severe mental illnesses aren’t getting treatment,” said report co-author, Dr. Jeffery Geller. “Someone with schizophrenia who is having a psychotic break should not be told they can’t get treatment in their own community, nor should they be told to wait and wait and wait for treatment. We are talking about people in need of immediate care.”
The states with the fewest beds in 2005 were: Nevada (5.1 beds per 100,000 people), Arizona (5.9), Arkansas (6.7), Iowa (8.1), Vermont (8.9) and Michigan (9.9). The states with the most beds available were South Dakota (40.3) and Mississippi (49.7). In 32 states the bed shortage was critical or severe, 42 states had less than half the minimum number of beds needed, and six states had less than 20 percent of the minimum beds needed to provide adequate care.
"One small silver lining in this otherwise alarming study is that Mississippi meets the 50 bed standard,” said study co-author and Treatment Advocacy Center executive director, Kurt Entsminger. “If the state which ranks 49 in per capita income can achieve the 50 bed standard, then states with greater wealth have no excuse for their failure to do so."
Consequences of Bed Shortage
Because there are so few beds available, individuals with severe psychiatric disorders who need to be hospitalized are often unable to get admitted. Those who are admitted are often discharged prematurely and without a treatment plan. The consequences of the radical reduction in psychiatric hospital beds are evidenced in the following areas:
- Homelessness. A 2005 federal survey estimated that approximately 500,000 single men and women are homeless in the United States at any given time and multiple studies have reported that one-third have a serious mental illness. A study in Massachusetts found that 27 percent of patients discharged from a state psychiatric hospital became homeless within six months of discharge; in a similar study in Ohio, the figure was 36 percent.
Jails and Prisons as Psychiatric Hospitals. Since the radical reduction in public psychiatric hospital beds there has been a massive increase in severely mentally persons in jails and prisons. Conservative estimates have placed the number at 7 to 10 percent of all inmates, but some studies have put the figure at 20 percent or higher. The three largest de facto psychiatric institutions in the United States are the Los Angeles County Jail, Chicago’s Cook County Jail, and New York’s Riker Island Jail.
Hospital Emergency Room Overflow. Emergency rooms are often used as waiting rooms for people in need of a psychiatric bed. This backs up the entire hospital system and compromises other medical care. In Arlington, Virginia, county officials had to call 31 hospitals before finding one that would accept a patient.
Violent Crime. Studies have shown that between 5 to 10 percent of seriously mentally ill persons who are not receiving treatment will commit a violent act each year. Such individual are responsible for at least 5 percent of all homicides.
The present severe shortage of public psychiatric beds should not be tolerated and can be ameliorated in the following ways:
Holding state governors and mental health officials responsible for the shortage.
Utilizing Programs of Assertive Community Treatment (PACT) and assisted outpatient treatment both of which have been proven to decrease hospitalization. These are alternatives to hospitalization and have excellent track records for success.
Modifying federal and state regulations to allow more flexibility in the utilization of alternatives to psychiatric hospitalization.
Making the public aware that the current severe shortage in public psychiatric beds is in part responsible for the increase in homelessness, number of mentally ill persons in jails and prisons; persons with mental illness in emergency rooms; and the increase in violence, including homicides in untreated individuals.
“There’s no question we need more public psychiatric beds, but the consequences of the severe bed shortage can also be improved with wide-spread utilization of PACT and [assisted outpatient treatment],” said Dr. Torrey.
“Both of these outpatient treatment options are proven successful ways to treat people with severe mental illnesses in the community. Assisted outpatient treatment has proven to reduce psychiatric hospitalizations by more than 70 percent.”