Psychiatric Bed Closures in Rural Hospitals: An Assessment of Trends, Impact, and Policy Strategies

The number of psychiatric beds has continued to decline both in community hospitals as well as in state psychiatric hospitals. These closures have resulted in severe shortages of inpatient care for people with mental illness. Correctional facilities as well as hospital emergency departments, skilled nursing facilities, nursing facilities, and healthcare providers bear the burden of the shortages of psychiatric inpatient beds. This problem is even greater in rural areas with their well-documented chronic shortages of mental health and psychiatric services.

Using mixed methods, we examined trends in psychiatric inpatient unit closures in rural hospitals and explored the impact on access to mental health and psychiatric services for residents of the areas served by hospitals that have closed their psychiatric bed. We addressed the following questions: (1) What are the trends in psychiatric bed closures by rural hospitals from 2010 through 2017 and (2) What changes in the local behavioral health services system (mental health) have occurred since the closure of psychiatric inpatient beds in rural communities? To understand potential policy responses to bed closures, the study examined initiatives in three states (Washington State, Vermont, and North Carolina) to convert excess rural hospital beds to provide inpatient psychiatric care.

The study used data from the Substance Abuse and Mental Health Services Administration Treatment Services Locator; the American Hospital Association Annual Survey of Hospitals (2010-2017), and the Area Health Resources File to identify trends in psychiatric bed closures by rural hospitals and access to mental healthcare in communities served by facilities that have closed their beds. We supplemented this analysis with interviews with mental health stakeholders in selected rural communities that have experienced recent psychiatric bed closures. Finally, we examined initiatives in two states (Washington and North Carolina) to convert excess rural hospital beds to provide inpatient psychiatric care and one state (Vermont) that has moved to reduce the number of beds at the state psychiatric hospital by expanding capacity in rural community hospitals.

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