Supply of Youth Psychiatric Hospital Beds Not Improving

As the number of youth who report significant mental health problems continues to rise, it would be at least somewhat reassuring to know that the capacity to treat these problems is also rising. Unfortunately, when it comes to youth needing psychiatric hospitalization, that does not seem to be the case, particularly if you live in certain states.

A recent study published in the journal JAMA Pediatrics used survey data to look at trends in pediatric inpatient psychiatric bed capacity across time and across the country. Psychiatric hospitalization is typically the last resort and highest level of care that can be offered to youth struggling with mental health problems and is usually reserved for those who are in imminent danger to themselves or others due to suicidality, psychosis, aggression, or weight loss (for people with eating disorders). If a hospital bed is not available, some of these youth are compelled to stay for long periods of time in emergency departments to wait for one while others get “discharged” home to their outpatient clinicians (if they have them) to manage as best they can. Can you imagine this kind of system for people who have heart attacks?

The study had two main findings.

First, there was quite a bit of variability in bed availability by state. The overall number of beds across the country was 15 per 100,000 youth, but this number ranged broadly from a low of 0 (Alaska) to a high of 75 (Arkansas). A color-coded map indicated that some of the lowest rates were in the west, in states such as Oregon, California, and Wyoming, while higher numbers were scattered across states like Alabama, Oklahoma, Missouri, and Maine.

Second, looking at the relatively short interval between 2017 and 2020, there were no significant increases or decreases in the total number of hospitals that offered inpatient psychiatric care for youth or the total number of beds. Just 6 percent of U.S. hospitals offered inpatient psychiatric care for youth (including hospitals that do only psychiatric care).

For those of us who work daily in pediatric mental health, these numbers confirm impressions we have had for many years—namely that resources for children with severe mental health problems are woefully inadequate and put youth and their families at significant risk. Further, the practice of trying to treat these youth in outpatient and community settings is likely contributing to the burnout and staffing shortages seen across many mental health clinics.

Why are there so few hospitals offering inpatient child psychiatry care? It shouldn’t shock folks that one of the main drivers is economics, as these facilities tend to be very labor-intensive and much less profitable than, for example, surgical services or radiological testing.

There is also, sadly, a great deal of infighting within the mental health community itself about where to spend the few dollars available. There certainly is an argument to be made that, rather than building more psychiatric units, we should invest more in early intervention and preventative services that can make an impact before a youth develops a severe mental health condition in the first place. This sounds great but, at the same time, we need to accept the reality that serious psychiatric disorders, just like serious medical conditions, are going to develop for some no matter how much prevention we offer, and these youth deserve the same level of accessible care as those who develop major medical conditions like cancer.

Hopefully, studies like these will provide some of the hard information we need to advocate for a healthcare system that truly values physical and mental health conditions equally. We sorely need increased mental health resources at all levels: preventative, community, and acute care if we are serious about reversing the troubling trends we are seeing with our youth today.