Sometimes patients are surprised that they will be transferred from an ER setting to a crisis stabilization unit or psychiatric emergency room, rather than directly to a psychiatric hospital.
The reason for this is largely logistical. Depending on where you live, psychiatric beds may be in very limited supply and in very high demand. The number of inpatient psychiatric beds has been dropping for decades. And while communities have attempted to implement alternative forms of care, there remains a core need for inpatient psychiatric beds. The United states has roughly 330 million people. At about 22 psychiatric beds per 100,000 people, that works out to about 73,000 psychiatric beds for the entire country. And realistically, most of those beds are near urban areas that can support multiple psychiatric facilities. My home state is California. In 2018, The California Hospital Association reported that of the nearly 440 general acute care hospitals (GACHs) in California, only 79 have dedicated psychiatric units. As of 2016, California had 32 hospitals licensed as freestanding acute psychiatric hospitals (APHs) and 26 county-based psychiatric health facilities (PHFs), which provide care only to individuals with acute behavioral health needs. Combined, these hospitals supplied the 6,702 beds available in the state for individuals in need of short-term, acute level of care, psychiatric inpatient services. Not all available psychiatric inpatient beds are associated with the same resources for patients. However, California has nearly 40 million residents. So that's about 1 psychiatric bed for every 6000 residents. However, current data suggests that 5.6% of US adults experienced serious mental illness in 2020. For California, that would have been nearly 2 million people. Data from 2018 suggests the median psychiatric hospitalization rate is typically 32.5 per 100,000 residents per year, so that could be expanded to predict California would have a psychiatric hospitalization need of 13,000 people per year. Psychiatric illness is not rare at all, so the need for locations provide intensive, specialty care will persist. So, yes, the beds are rare, even in populous states, and they are very very needed. You will find that the the care system treats inpatient beds as a precious resource, because they are. In general, patients are only admitted to an inpatient setting if there is no lower level of care available that is appropriate and safe. I'll write more about that concept in a future post.
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