A class action suit—Arnold v. Sarn—was filed in 1981 against the State of Arizona, alleging that the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS) and Maricopa County did not provide a comprehensive community mental health system as required by statute. The case proceeded through the court system (slowly), and an agreement was reached between the parties in 2014, which resulted in a Stipulation for Providing Community Services and Terminating Litigation. There were other decision points made during this case, one of which was that the number of long-term psychiatric care beds available at Arizona State Hospital (the only hospital in Arizona which offers long-term psychiatric care) for Maricopa County would be 55 (for those committed under Title 36, i.e., civil commitment). This number, seemingly plucked out of thin air, is absurd considering the size of the population it serves (about 4,500,000 people in Maricopa County, so this equates to 1.2 beds per 100,000 available for long-term psychiatric care).
As you can see from the article by Research weekly, a publication of the Treatment Advocacy Center, the optimal number of long-term psychiatric beds available in any population should be around 60, with 30 beds acceptable as a bare minimum.
As an organization devoted to the care of people with SMI, ACMI is intent on removing this absurd artificial limit to bed capacity at ASH for those unfortunates who happen to live in Maricopa County, Arizona, one of the largest counties in the US, with the smallest capacity to serve people with this terrible disease.
Charles Goldstein, M.D. ACMI Treasurer
RESEARCH WEEKLY: Two New Studies on Psychiatric Bed Number Targets
By Elizabeth Sinclair Hancq
(March 2, 2022) Two research reports on the optimum number of psychiatric beds have been published in the past few months, both of which validate the Treatment Advocacy Center’s recommendation for 40 to 60 beds per 100,000 population.
In this week’s Research Weekly blog, I will first review the Treatment Advocacy Center recommendations and then summarize the two new studies that support those numbers.
Treatment Advocacy Center bed recommendations
Treatment Advocacy Center published a study in 2008 that included a safe minimum number of psychiatric beds, concluding that there is “a need for 50 (range 40 to 60) public psychiatric beds per 100,000 population for hospitalization for individuals with serious psychiatric disorders.” This is considered a minimum number because it assumes the availability of good outpatient programs, including assisted outpatient treatment.
This recommendation was developed utilizing the Delphi method, a structured technique to develop a consensus from a variety of experts. Treatment Advocacy Center collected input from 15 experts on psychiatric care in the United States to inform the estimates. The experts were instructed to take into consideration a variety of factors that impact the need for psychiatric beds, including the number of people with serious mental illness who may need hospital care, the adequacy of community outpatient services, how long individuals usually remain in hospitals, short stay versus long stay beds, and how the psychiatric beds are financed.
RAND Corporation bed recommendations for California
The RAND Corporation is a nonprofit and nonpartisan research organization that conducts research to inform public policy challenges. RAND was contracted by the California Mental Health Services Authority to conduct a research analysis to estimate psychiatric bed need in California for the next five years, including variations for types of beds and regional needs throughout the state. The results of the study were published in January.
The study authors first determined the current psychiatric bed capacity in California, breaking down the beds to acute and subacute type beds. Acute beds were described as those for higher acuity patients and shorter lengths of stay (days to weeks), typically utilized to stabilize patients. Subacute beds were defined as those used for individuals with moderate to high acuity needs but for a longer duration (multiple months).
They estimated the bed needs in the state using multiple methods. In one method, they convened a panel of technical experts, of which I was a member, to discuss estimates of bed need and the various factors that impact psychiatric bed capacity numbers, including how they are utilized and what types of patients they serve. Secondly, they utilized regional variation in rates of serious psychological distress to estimate how bed need may differ by region of the state. Thirdly, they computed the number of beds required by using a formula that includes how many beds currently exist and current bed occupancy rates, wait list volumes, average length of stay and transfers needed to higher or lower levels of care.
The RAND report authors found that California requires 50.5 inpatient psychiatric hospital beds per 100,000 adults, which is consistent with the Treatment Advocacy Center findings. The authors further break these numbers down by type of bed, suggesting that these bed targets include 26 acute beds per 100,000 adult population and 24.6 subacute beds per 100,000 population. Taking into account how many beds California currently has, the results suggest that California is short 1,971 acute beds and 2,796 subacute beds. In addition, the authors conclude that the shortage of psychiatric beds will only worsen over time, predicting a 1.7% increase in psychiatric bed need by 2026.
International Delphi Method
The other new research report on psychiatric bed supply need per capita was an international effort conducted by a group of researchers from around the world and published in Molecular Psychiatry in January. These researchers again utilized the Delphi method to reach a global consensus on the minimum and optimum number of psychiatric beds per population. The Delphia panel included 65 experts, including me, from 40 different countries. These included individuals from all six World Health Organization regions and those from high- and low- income countries.
The results of the Delphi process concluded that 60 beds per 100,000 population is the optimal number, and 30 beds per 100,000 population is the absolute minimum. A psychiatric bed supply range of 25-30 was considered a mild shortage, 15-25 as a moderate shortage, and less than 15 per 100,000 population as a severe shortage of psychiatric beds. The results from this international panel of experts are again consistent with Treatment Advocacy Center’s psychiatric bed recommendations.
These two new psychiatric bed capacity target research studies further validate Treatment Advocacy Center’s previous report on the subject, suggesting a given jurisdiction should have at least 40-60 inpatient psychiatric beds per 100,000 population to meet the needs of their community.
- McBain, R.K., et al. (2022, January). Adult psychiatric bed capacity, need, and shortage estimates in California—2021. RAND Corporation.
- Mundt, A.P. et al. (2022, January). Minimum and optimal numbers of psychiatric beds: Expert consensus using a Delphia process. Molecular Psychiatry.
- Office of Research and Public Affairs. (2016). Psychiatric bed supply need per capita. Treatment Advocacy Center.
- Torrey, E. F., et al. (2008). The shortage of public hospital beds for mentally ill persons. Treatment Advocacy Center.
Elizabeth Sinclair Hancq is the director of research at Treatment Advocacy Center.
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Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.