The United States needs to increase the number of long-term inpatient psychiatric care centers to better accommodate those with severe mental illness, according to an opinion piece published in JAMA Psychiatry.
The number of inpatient psychiatric beds in the United States has seen an extreme drop off in the past 60 years. In 1955, state psychiatric facilities cared for 560,000 patients; today, they have only 45,000 patients. If you account for the doubling of the country’s population, this represents a 95% decline.
Approximately 10 million people in the United States have a serious mental illness; the number of beds in inpatient psychiatric treatment centers can accommodate only a small fraction of these people.
As new drugs and better outpatient therapy became more affordable and widespread, it led to the closure of many inpatient psychiatric hospitals. However, these new treatment options were not adequate for patients with severe, chronic mental illness, and many had to be moved to nursing homes or general hospitals. For those who couldn’t afford care there, many become homeless or wound up incarcerated. Often, this becomes a cycle: prison, homelessness, acute hospitalization, and re-incarceration.
The more ethical and financially sound option to treat those with mental illness who cannot live independently is to revisit psychiatric hospitals. If the United States opens more modernized, humane facilities, they can give people with severe mental illness a stable living situation, reducing the number of homeless and incarcerated people.
This Viewpoint discusses new models for patient-centered, long-term psychiatric care in the United States.
During the past half century, the supply of inpatient psychiatric beds in the United States has largely vanished. In 1955, 560 000 patients were cared for in state psychiatric facilities; today there are fewer than one-tenth that number: 45 000.1 Given the doubling of the US population, this represents a 95% decline, bringing the per capita public psychiatric bed count to about the same as it was in 1850—14 per 100 000 people.1 A much smaller number of private psychiatric beds has fluctuated since the 1970s in response to policy and regulatory shifts that create varying financial incentives.