The Shortage of Public Hospital Beds for Mentally Ill Persons

A Report of the Treatment Advocacy Center
E. Fuller Torrey, M.D.*, D. J. Jaffe, B.S., M.B.A.*, Kurt Entsminger, J.D.**, Jeffrey Geller, M.D.*, Jonathan Stanley, J.D.**,

* Member of the Board, Treatment Advocacy Center
** Staff, Treatment Advocacy Center
www.treatmentadvocacycenter. org

For complete hospital beds for mentally ill report, including state-by-state shortages, download pdf


Since the 1960s there has been a mass exodus of patients from public psychiatric hospitals. Data are available on the number of patients in such hospitals in 1955 and in 2004– 2005. The data show that:

In 2005 there were 17 public psychiatric beds available per 100,000 population compared to 340 per 100,000 in 1955. Thus, 95 percent of the beds available in 1955 were no longer available in 2005.

The states with the fewest beds were Nevada (5.1 per 100,000), Arizona (5.9), Arkansas (6.7), Iowa (8.1), Vermont (8.9), and Michigan (9.9). The states with the most beds were South Dakota (40.3) and Mississippi (49.7).

A consensus of experts polled for this report suggests that 50 public psychiatric beds per 100,000 population is a minimum number. Thus, 42 of the 50 states had less than half the minimum number needed, and Mississippi was the only state to achieve this goal.

The total estimated shortfall of public psychiatric beds needed to achieve a minimum level of psychiatric care is 95,820 beds.

The consequences of the severe shortage of public psychiatric beds include increased homelessness; the incarceration of mentally ill individuals in jails and prisons; emergency rooms being overrun with patients waiting for a psychiatric bed; and an increase in violent behavior, including homicides, in communities across the nation. ? The consequences of the severe shortage in public psychiatric beds could be improved with the widespread utilization of PACT (Program of Assertive Community Treatment) programs and assisted outpatient treatment (AOT), both of which have been proven to 3 decrease hospitalization. It could also be improved with greater flexibility in federal and state regulations allowing for the development of alternatives to hospitalization.

I. Introduction to shortage of hospital beds for mentally ill persons

The mass exodus of patients from public mental hospitals, known as deinstitutionalization, began in the 1960s. It was driven by a variety of factors:

1. Public revelations following World War II that most state mental hospitals were grossly overcrowded and that patients were living in squalid conditions, e.g., Albert Deutsch’s 1948 exposé The Shame of the States.

2. The introduction in 1954 of chlorpromazine (Thorazine), the first effective antipsychotic, which made it possible, for the first time, to control the symptoms of schizophrenia and thus discharge some patients.

3. The creation in the 1960s of federal programs such as SSI, SSDI, Medicaid, and Medicare, which provided fiscal support with federal funds for mentally ill individuals who were living in the community. Patients in state hospitals, however, were not eligible (with a few exceptions) for Medicaid and SSI. Since state mental hospitals continued to be almost completely funded with state funds, these federal programs created a huge incentive for states to discharge patients to the community and thus effectively shifted the cost of their care from the state to the federal government. Fiscal conservatives in the state legislatures therefore strongly encouraged deinstitutionalization. 4. The emergence of a group of young, civil libertarian lawyers in the 1960s who decided that mental patients needed to be “liberated.” They implemented a series of successful lawsuits, forcing states to discharge mental patients and making rehospitalization exceedingly difficult.

4 It is important to realize that very little was known about the causes of severe psychiatric disorders when deinstitutionalization was getting underway in the 1960s. Influential figures such as Dr. Thomas Szasz argued that mental illness was a myth (The Myth of Mental Illness, 1961). Others, such as sociologist Erving Goffman (Asylums, 1961) and novelist Ken Kesey (One Flew Over the Cuckoo’s Nest, 1962), argued that being hospitalized was itself causing the patients’ mental problems and that patients would be much better off if simply discharged. The history of deinstitutionalization, with its odd coalition of fiscal conservatives and civil rights liberals, has been thoroughly documented elsewhere.

For complete hospital beds for mentally ill report, including state-by-state shortages, download pdf