Citation

Bastiampillai T, Sharfstein SS, Allison S. J. Am. Med. Assoc. JAMA 2016; 316(24): 2591-2592.

Affiliation

Discipline of Psychiatry, School of Medicine, Flinders University, Adelaide, Australia.

Copyright

(Copyright © 2016, American Medical Association)

DOI

10.1001/jama.2016.16989

PMID

27812693

Abstract

he closure of most US public mental hospital beds and the reduction in acute general psychiatric beds over recent decades have led to a crisis, as overall inpatient capacity has not kept pace with the needs of patients with psychiatric disorders. Currently, state-funded psychiatric beds are almost entirely forensic (ie, allocated to people within the criminal justice system who have been charged or convicted). Very limited access to nonforensic psychiatric inpatient care is contributing to the risks of violence, incarceration, homelessness, premature mortality, and suicide among patients with psychiatric disorders. In particular, a safe minimum number of psychiatric beds is required to respond to suicide risk given the well-established and unchanging prevalence of mental illness, relapse rates, treatment resistance, nonadherence with treatment, and presentations after acute social crisis. Very limited access to inpatient care is likely a contributing factor for the increasing US suicide rate. In 2014, suicide was the second-leading cause of death for people aged between 10 and 34 years and the tenth-leading cause of death for all age groups, with firearm trauma being the leading method.

Currently, the United States has a relatively low 22 psychiatric beds per 100 000 population compared with the Organisation for Economic Cooperation and Development (OECD) average of 71 beds per 100 000 population. Only 4 of the 35 OECD countries (Italy, Chile, Turkey, and Mexico) have fewer psychiatric beds per 100 000 population than the United States. Although European health systems are very different from the US health system, they provide a useful comparison. For instance, Germany, Switzerland, and France have 127, 91, and 87 psychiatric beds per 100 000 population, respectively.

Furthermore, between 1998 and 2013, the total number of psychiatric beds in the United States decreased from 34 to 22 beds per 100 000 population, a 35% reduction from an already low base rate of psychiatric beds per population. This reduction in the numbers of psychiatric beds led to higher bed occupancy rates, significantly lower average inpatient length of stay, and prolonged emergency department waiting times for patients with psychiatric illness who need to be hospitalized, all of which has contributed to an increased threshold for admission and decreased threshold for discharge for patients at risk of suicide.

Language: en