APA Unveils Tool for Addressing Psych Bed Crisis

The American Psychiatric Association (APA) released a comprehensive report to address the shortage of hospital beds for inpatient psychiatric care during a press conference Tuesday.

The report described a predictive modeling tool developed to help hospital groups and other community-based groups determine how many inpatient hospital beds might be needed at any given time. It was demonstrated to reporters but has not yet been made available online, pending further refinement.

Just how short the number of available beds is at any given time might be a “seemingly simple question,” but one that the APA task force found not so simple in real-world settings:

“Today, amidst a mental health crisis, communities have no effective means to assess how many beds they need to meet demand in their population,” the online overview for the report noted. “Too often, psychiatric inpatient beds are not available when needed and people with mental illnesses end up boarding in emergency departments or being discharged prematurely. In worst-case scenarios, inaccessible treatment results in homelessness or involvement with the criminal justice system.”

State-run hospital beds for psychiatric care declined substantially from 337 per 100,000 people in the mid-1950s to 11.7 per 100,000 in 2016. But overall need for inpatient hospital beds did not increase, according to the new report, suggesting the main driver of the crisis is a limited supply of beds.

There are several factors that have led to this decline in these beds, according to Anita Everett, MD, a past president of the APA and chair of the task force that wrote the report. She noted that after the Community Mental Health Services Act was passed nearly 60 years ago, the mental healthcare system has not consistently delivered the necessary services and resources for patients.

“We knew that we needed to take into account all the factors that we know contribute to mental illnesses … that would result in hospitalization,” Everett said during the press conference. “In short, we quickly realized we weren’t living in a binary world anymore. It was not all inpatient and nothing else. We needed to be able to characterize this system.”

Where there has been an increase in need is for children and adolescents, according to Sandra DeJong, MD, the chair of the APA’s task force subgroup focused on this population.

Over the last 30 years, the availability of inpatient child psychiatry beds has decreased, even as demand has increased, according to DeJong. This is compounded by the shortage of child psychiatrists.

“If you look at the American Academy of Child and Adolescent Psychiatry workforce maps, you’ll see that the vast majority of the country has a severe shortage of child psychiatrists,” she said.

DeJong noted that the report breaks down more than 10 ways that the needs of this group differ from the adult population and require very different approaches to resource management related to their care, including advocating for care in the least restrictive settings to minimize trauma from separating children from their families.

“The first is that children and adolescents are a vulnerable, independent population that we actually are legally mandated to ensure safety of,” DeJong said during the press conference.

Other takeaway points were that child patient services should take into consideration the specific needs of the child and their family and that there’s a big need for development of healthcare use data, clinical standards, and quality measures for youth mental health needs.

“Just increasing inpatient beds alone won’t fix the current crisis,” DeJong said.