California s Acute Psychiatric Bed Loss January 11, 2018 As of 2015, California had 29 hospitals licensed as freestanding Acute Psychiatric Hospitals (APH) and 28 county-based Psychiatric Health Facilities (PHF), which provide care only to individuals with acute behavioral needs. An additional 80 facilities are dedicated psychiatric units within General Acute Care Hospitals (GACH). California has nearly 440 GACHs, of which about one-fifth have such dedicated psychiatric units. Combined, these hospitals supply the 6,610 beds available around the state for individuals in need of short-term, acute level of care, psychiatric inpatient services. The primary data source for this report is the current (2015) financial and utilization data reports from the Office of Statewide Health Planning and Development (OSHPD). It is important to note that none of the data in this document includes beds from the five very large, state-owned hospitals in Fresno, Napa, Los Angeles, San Bernardino, and San Luis Obispo Counties, since the beds in these facilities are typically not available to the general public, with most patients being admitted by court order. The remaining pages of this document are described below. Acute Psychiatric Inpatient Bed Closures/Downsizing Pages 2-4 These pages contain graphs illustrating the severity of the bed loss in the state. The first page, first chart shows the loss in the number of facilities with inpatient psychiatric beds since 1995. The state has lost 44 facilities, either through the elimination of psychiatric inpatient care, or complete hospital closure, a nearly 25% drop. The second chart shows the decline in beds from 1995 to the present. While there was an increase in beds since 2012, California has lost nearly 30% of the beds it had in 1995, a drop of nearly 2800 beds. The third chart displays the increase in the patient-to-bed gap, statewide. A panel of 15 leading psychiatric experts was consulted and asked to look at specific criteria such as number of individuals who need hospitalization, the average length of hospital stays, and current state and federal financing structures. Using these criteria, the panel concluded that 50 public psychiatric beds per 100,000 individuals (or 1:2000) is the absolute minimum number required to meet current needs. This number, however, is contingent upon the availability of appropriate outpatient services in the community. In 1995, California fell short of this target by nearly 1,400 beds, having only 29.5 beds per 100,000 residents. That gap has increased to nearly 4,000 beds in 2015, with the state having.91 psychiatric inpatient beds for every 100,000 residents. This is a loss of over 42% of the beds per capita in California since 1995. The fourth chart shows the increase in California s population over the same period of time. Since 1995, the state has gained more than seven million people, a growth of more than 20%, with the 2015 population of more than 39 million. Pages 3 and 4 show similar tracking for Child/Adolescent beds and PHF beds. Psychiatric Inpatient Care Units and Freestanding Psychiatric Hospitals Comparative Data Page 5 This page provides a comparison of California to the rest of the United States. National data comes from the American Hospital Association s (AHA) Annual Survey of Hospitals. From these figures, we subtracted California s numbers to arrive at the 49-state data. Census data was used to calculate the number of beds per person. California s bed rate is one bed for every 5,922 people, as of 2015, worse than the rest of the nation s average of one bed for every 4,900 people. California s crisis is not unique, but we fare far worse, comparatively. Acute Care Inpatient Psychiatric Bed Distribution by County Page 6 This page of the document breaks California data down by county in an attempt to illustrate the different types of beds available. Also listed are beds reserved for patients with chemical dependency needs and beds in Psychiatric Health Facilities. All data is from OSHPD annual reports. The chart also shows that 25 of California s 58 counties have no inpatient psychiatric services. The remaining pages 7-14 visually show the bed distribution across the state, illustrating the vast areas between and without particular services. This document is considered public information and may be distributed freely. It is updated annually, typically in September or October, and is available for download at www.calhospital.org/psychbeddata.
Acute Psychiatric Inpatient Bed Closures/Downsizing California, 1995-2015 PSYCH FACILITY CHANGE 1995 181 2015 137 Total Change -44 % Change -24.3% 190 180 170 Total Psych Facilities 1995 2015 181 178 174 174 8 172 7 5 2 Facilities 0 150 140 157 152 145 140 140 142 141 136 136 137 137 137 130 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 PSYCH BED CHANGE 1995 9353 2015 6610 Total Change -2743 % Change -29.3% Bed Count 9500 9000 8500 8000 7500 7000 6500 6000 9353 8544 82 8208 80 Total Psych Beds 1995 2015 7741 7595 7493 7360 7179 6871 6598 6510 6551 6598 6573 6505 6574 6587 6610 6331 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 BED GAP PROGRESS 1995 29.50 2015.91 Total Change -12.59 % Change -42.7% Extrapolated from Treatment Advocacy Center figure of 1 bed per 2000. Beds per 100,000 People 50.00 40.00 30.00 20.00 10.00 29.50 Beds to Population 1995 2015 Goal is 50 beds per 100,000 people. 25.28 23.93 26.70 22.01 24.87 20.85 19.19 17.98 17.83.66 17. 22.83 21.47 20.17.91 18.33 17.90 17.62 17.12.98 0.00 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 POPULATION GROWTH 1995 31.7 2015 39.1 Total Change 7.4 % Growth 23.3% estimated in millions Population (in millions) 40 39 38 37 36 35 34 33 31 30 31.7.5 33 33.5 California Population 1995 2015 34.9 35.3 35.6 35.8 36 36.2 34.5 33.9 36.6 37 37.3 38.8 39.1 38 38 38.3 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Psych Data Source: OSHPD (Includes city and county hospitals, but not state hospitals. Also includes Psychiatric Health Facilities. Population Data Source: U.S. Census Bureau Updated 1/2/2018 Contact: Sheree Lowe, VP Behavioral Health California Hospital Association The current version is posted at: www.calhospital.org/psychbeddata 1215 K St., Ste. 800 Sacramento, CA 95814 slowe@calhospital.org (9) 552-7576 2
Child/Adolescent Acute Psychiatric Inpatient Bed Closures/Downsizing California, 2009-2015 PSYCH FACILITY CHANGE 2009 31 2015 29 Total Change -2 % Change -6.5% Facilities 35 34 33 31 30 29 28 27 26 25 Total Psych Facilities w/child Adolescent Beds 2009 2015 31 28 28 28 28 1 2 3 4 5 6 7 29 PSYCH BED CHANGE 2009 745 2015 665 Total Change -80 % Change -10.7% 900 850 800 Total Psych Child Adolescent Beds 2009 2015 820 Bed Count 750 700 650 600 745 691 661 655 655 665 1 2 3 4 5 6 7 BED GAP PROGRESS 2009 8.00 2015 7.69 Total Change -0.31 % Change -3.9% Extrapolated from Treatment Advocacy Center figure of 1 bed per 2000. Beds per 100,000 People 50 40 30 20 10 Beds to Population, Child Adolescent 2009 2015 Goal is 50 beds per 100,000 people. 8.00 8.85 7.51 7.22 7.20 7.20 7.69 0 2009 2010 2011 2012 2013 2014 2015 POPULATION GROWTH 2009 9.31 2015 9.1 Total Change -0.21 % Growth -2.3% estimated in millions Population (in millions) 10 9.8 9.6 9.4 9.2 9 8.8 8.6 8.4 8.2 8 California Under 18 Population 2009 2015 9.31 9.27 9.2 9.15 9.1 9.1 9.1 2009 2010 2011 2012 2013 2014 2015 Psych Data Source: OSHPD (Includes city and county hospitals, but not state hospitals. Also includes Psychiatric Health Facilities. Population Data Source: U.S. Census Bureau Updated 1/2/18 Contact: Sheree Lowe, VP Behavioral Health California Hospital Association The current version is posted at: www.calhospital.org/psychbeddata 1215 K St., Ste. 800 Sacramento, CA 95814 slowe@calhospital.org (9) 552-7576 3
Bed Count Facilities Psychiatric Health Facility (PHF) Closures/Downsizing California, 2000-2015 FACILITY CHANGE 2000 2015 27 Total Change 11 % Change 68.8% 30 25 Total Psychiatric Health Facilities 2000-2015 23 22 22 21 21 22 25 27 20 15 15 17 18 10 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 BED CHANGE 2000 351 2015 484 Total Change 133 % Change 37.9% 495 485 475 465 455 445 435 425 415 405 395 385 375 365 355 345 335 5 Total PHF Beds 2000-2015 484 452 445 445 418 407 400 404 408 391 391 391 398 379 376 351 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Psych Data Source: OSHPD Updated 1/2/2018 Contact: Sheree Lowe, VP Behavioral Health California Hospital Association The current version is posted at: www.calhospital.org/psychbeddata 1215 K St., Ste. 800 Sacramento, CA 95814 slowe@calhospital.org (9) 552-7576
Psychiatric Inpatient Care Units and Freestanding Psychiatric Hospitals 2015 Comparative Data Nation and California GACHs¹ w/psych # Psych Beds APHs² & PHFs³ # Psych Beds Total Hospitals Total Beds Nation 1187 37,717 223 26,229 1410 63,946 49 States 1107 34,188 6 23,148 1273 57,336 California 80 3529 57 3081 137 6610 2015 Population Comparison Nation 0,090,857 1 psych bed for every 5006 people 49 States 280,946,039 1 psych bed for every 4900 people California 39,144,818 1 psych bed for every 5922 people Experts estimate a need for a minimum of 1 public psychiatric bed for every 2000 people for hospitalization for individuals with serious psychiatric disorders. This number is contingent upon the availability of appropriate outpatient services in the community. ¹ General Acute Care Hospitals ² Acute Psychiatric Hospitals ³ Psychiatric Health Facilities Sources National data: Health Forum, AHA Annual Survey of Hospitals Hospitals with psychiatric or alcoholism/chemical dependency units are registered community hospitals that reported having such a unit for that year. Acute Psychiatric Hospitals also include children s psychiatric hospitals, but exclude chemical dependency hospitals. State owned facilities are similarly excluded. California data: OSHPD General Acute Care Hospitals include city and county hospitals, but not state hospitals. Acute Psychiatric Hospitals include city and county hospitals, but not state hospitals. Also includes county-owned Psychiatric Health Facilities. 49 State data: OSHPD data subtracted from AHA data. Includes the District of Columbia. Population data: U.S. Census Bureau Torrey, E. F., Entsminger, K., Geller, J., Stanley, J. and Jaffe, D. J. (2008). The Shortage of Public Hospital Beds for Mentally Ill Persons. Stetka, B. (2010). US Psychiatric Resources: A Country in Crisis. Contact: Sheree Lowe, VP Behavioral Health California Hospital Association 1215 K St., Ste. 800 Sacramento, CA 95814 (9) 552-7576 slowe@calhospital.org Revised 1/11/18 This document is updated annually (typically September or October). The current version can be found on the CHA website at www.calhospital.org/psychbeddata. 5
Acute Care Inpatient Psychiatric Bed Distribution Not all beds are available to individuals on LPS involuntary holds. Does not include data from state-operated hospitals. County Adult Child/Adol Gero-Psych Psych IC PHF¹ Chem/Dep¹ Beds per 100k² Beds Needed³ Population County Alameda 279 70 0 0 42 74 21.30 819 1,638,215 Alameda Alpine 0 0 0 0 0 0 0.00 1 1,110 Alpine Amador 0 0 0 0 0 0 0.00 19 37,001 Amador Butte 46 0 0 0 0 20.41 113 225,411 Butte Calaveras 0 0 0 0 0 0 0.00 22 44,828 Calaveras Colusa 0 0 0 0 0 0 0.00 11 21,482 Colusa Contra Costa 84 24 0 0 0 8 9.59 563 1,126,745 Contra Costa Del Norte 0 0 0 0 0 0 0.00 14 27,254 Del Norte El Dorado 0 0 0 0 8.67 92 184,452 El Dorado Fresno 77 0 0 0 9.54 487 974,861 Fresno Glenn 0 0 0 0 0 0 0.00 14 28,017 Glenn Humboldt 0 0 0 0 11.79 68 135,727 Humboldt Imperial 0 0 0 0 0 0 0.00 90 180,191 Imperial Inyo 0 0 0 0 0 0 0.00 9 18,260 Inyo Kern 140 0 0 0 0 15.87 441 882,176 Kern Kings 0 0 0 0 0 0 0.00 75 150,965 Kings Lake 0 0 0 0 0 0 0.00 64,591 Lake Lassen 0 0 0 0 0 0 0.00 31,345 Lassen Los Angeles 1969 231 0 86 251 22.48 5,085 10,170,292 Los Angeles Madera 0 0 0 0 0 0 0.00 77 154,998 Madera Marin 17 0 0 0 0 0 6.51 131 261,221 Marin Mariposa 0 0 0 0 0 0 0.00 9 17,531 Mariposa Mendocino 0 0 0 0 0 0 0.00 44 87,649 Mendocino Merced 0 0 0 0 5.96 134 268,455 Merced Modoc 0 0 0 0 0 0 0.00 4 8,965 Modoc Mono 0 0 0 0 0 0 0.00 7 13,909 Mono Monterey 40 0 0 0 0 0 9.22 217 433,898 Monterey Napa 37 0 0 0 0 0 25.97 71 142,456 Napa Nevada 0 0 0 0 0 0 0.00 49 98,877 Nevada Orange 452 0 0 0 122 15.27 1,585 3,9,776 Orange Placer 0 0 0 0 4.26 188 375,391 Placer Plumas 0 0 0 0 0 0 0.00 9 18,409 Plumas Riverside 191 12 0 9 121 8.98 1,181 2,361,026 Riverside Sacramento 343 57 0 0 82 0 26.64 751 1,501,335 Sacramento San Benito 0 0 0 0 0 0 0.00 29 58,792 San Benito San Bernardino 283 76 0 0 0 18.87 1,064 2,128,133 San Bernardino San Diego 492 65 0 149 0 31 21.40 1,650 3,299,521 San Diego San Francisco 272 0 47 0 0 0 36.89 4 864,8 San Francisco San Joaquin 50 0 0 0 1 6.89 363 726,106 San Joaquin San Luis Obispo 0 0 0 0 5.69 141 281,401 San Luis Obispo San Mateo 79 15 24 0 0 10 15.42 383 765,135 San Mateo Santa Barbara 36 0 0 0 34 8.09 222 444,769 Santa Barbara Santa Clara 6 0 0 0 40 0 8.65 959 1,918,044 Santa Clara Santa Cruz 0 0 0 0 5.84 137 274,146 Santa Cruz Shasta 37 0 0 0 0 20.61 90 179,533 Shasta Sierra 0 0 0 0 0 0 0.00 1 2,967 Sierra Siskiyou 0 0 0 0 0 0 0.00 22 43,554 Siskiyou Solano 64 13 0 0 0 17.66 218 436,092 Solano Sonoma 75 20 0 0 0 0 18.92 251 502,146 Sonoma Stanislaus 83 0 0 0 0 15.42 269 538,388 Stanislaus Sutter 0 0 0 0 33.17 48 96,463 Sutter Tehama 0 0 0 0 0 0 0.00 63,308 Tehama Trinity 0 0 0 0 0 0 0.00 7 13,069 Trinity Tulare 63 0 0 0 0 0 13.70 230 459,863 Tulare Tuolumne 0 0 0 0 0 0 0.00 27 53,709 Tuolumne Ventura 96 34 0 0 0 0 15.28 425 850,536 Ventura Yolo 31 0 0 0 0 0 14.55 107 213,0 Yolo Yuba 0 0 0 0 0 0 0.00 37 74,492 Yuba TOTALS All Psych Adult Child/Adol Gero-Psych Psych IC PHF¹ Chem/Dep¹ Beds per 100k² Beds Needed State 6,610 5,630 665 71 244 484 670.89 19,572 39,144,818 25 Counties w/o Adult Beds (45% of state) Sources: Population data from US Census Bureau 45 Counties w/o Child/Adolescent Beds (78% of state) All other data from OSHPD 2015 reports 56 Counties w/o Gero-Psych (Long-Term Care) Beds (97% of state) 55 Counties w/o Psych Intensive Care Beds (95% of state) ¹ NOTE: PHF bed totals are included in their respective categories (e.g., adult, 48 Counties w/o Chemical Dependency Beds (83% of state) child/adolescent, etc.). Chemical Dependency beds are not included. 25 Counties Have ZERO Inpatient Psych Services (45% of state) ² NOTE: Beds per 100,000 residents goal is 50 ³ NOTE: Lacking sufficient community resources Gero-Psych - Medical care, nursing and auxiliary professional services and intensive supervision of the chronically mentally ill, mentally disordered or other mentally incompetent geriatric persons, rendered in the structured, secure, therapeutic milieu of a psychiatric long-term care program. Psych IC (Psychiatric Intensive Care) - Provides nursing care to psychiatric patients which is of a more intensive nature than the usual nursing care provided in Medical, Surgical, and Psychiatric Units. PHF (Psychiatric Health Facility) - Defined as a health facility, licensed by the State Department Health Care Services, that provides 24-hour inpatient care. This care includes, but is not limited to: psychiatry, clinical psychology, psychiatric nursing, social work, rehabilitation, drug administration, and appropriate food services for those persons whose physical health needs can be met in an affiliated hospital or in outpatient settings. (Health & Safety Code Section 1250.2) Contact: Sheree Lowe, VP Behavioral Health California Hospital Association Revised: 1/11/2018 1215 K St., Ste. 800 Sacramento, CA 95814 (9) 552-7576 The current version is posted at: www.calhospital.org/psychbeddata slowe@calhospital.org
Acute Care Inpatient Psychiatric Bed Distribution Counties with Psychiatric Inpatient Beds This includes inpatient psychiatric beds in freestanding Acute Psychiatric Hospitals, General Acute Care Hospitals, and Psychiatric Health Facilities. 37 46 95 31 17 37 77 400 319 118 108 349 50 83 6 93 40 63 140 36 359 Total Facilities 137 130 2286 Total Beds 6610 Total Counties With Psych Beds 33 484 212 Total Counties Without Psych Beds 25 706 Source: OSHPD 2015 data Updated January 11, 2018 7
Acute Care Inpatient Psychiatric Bed Distribution Counties with Freestanding Acute Psychiatric Hospitals (APH) 95 Acute Psychiatric Hospitals are subject to the federal Institutions for Mental Disease (IMD) exclusion, which is found in section 1905(a)(B) of the Social Security Act. It prohibits federal Medicaid matching payments with respect to care or services for any individual who has not attained 65 years of age and who is a patient in an institution for mental diseases except for inpatient psychiatric hospital services for individuals under age 21. The law applies to any hospital, nursing facility, or other institution of more than beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services. The IMD exclusion was intended to ensure that states, rather than the federal government, would have principal responsibility for funding inpatient psychiatric services. 318 61 65 34 80 148 177 87 Total Facilities 29 Total Beds 2582 Total Counties With APH 13 Total Counties Without APH 45 913 138 68 398 Source: OSHPD 2015 data Updated January 11, 2018 8
Acute Care Inpatient Psychiatric Bed Distribution Counties with General Acute Care Hospitals (GACH) with Dedicated Psychiatric Units 21 30 37 31 318 17 239 43 159 28 67 118 126 61 40 63 124 182 Total Facilities 80 20 43 1341 Total Beds 3529 Total Counties With GACH psych 22 Total Counties W/O GACH psych 36 344 115 308 Source: OSHPD 2015 data Updated January 11, 2018 9
Acute Care Inpatient Psychiatric Bed Distribution Counties with Non-Hospital Psychiatric Health Facilities (PHF) A psychiatric health facility (PHF) is defined as a health facility, licensed by the State Department of Health Care Services, that provides 24-hour inpatient care. This care includes, but is not limited to: psychiatry, clinical psychology, psychiatric nursing, social work, rehabilitation, drug administration, and appropriate food services for those persons whose physical health needs can be met in an affiliated hospital or in outpatient settings. (Health & Safety Code Section 1250.2) 98 42 40 Total Facilities 28 Total Beds 497 29 Total Counties With PHF 20 Total Counties Without PHF 38 Source: OSHPD 2015 data Updated January 11, 2018 10
Acute Care Inpatient Psychiatric Bed Distribution Counties with Psychiatric Inpatient Beds for Adults Note: Adult beds are for those aged 18 and older. These beds are found in general acute hospitals (GACH), freestanding acute psychiatric hospitals (APH), and psychiatric health facilities (PHF). 37 46 31 75 64 37 343 17 84 272 279 83 79 50 6 77 63 40 140 283 36 Total Facilities 137 Total Beds 5630 Total Counties With Psych Beds 33 96 1969 191 452 Total Counties Without Psych Beds 25 492 Indicates a county with a non-hospital Psychiatric Health Facility Source: OSHPD 2015 data Updated January 11, 2018 11
Acute Care Inpatient Psychiatric Bed Distribution Counties with Inpatient Beds for Children/Adolescents Note: There is no state definition regarding age ranges for child vs. adolescent beds. The definitions are hospital -specific, i.e., one facility may consider adolescent to mean ages 11 to 17, while another may consider it to be 12 to 17. Because child and adolescent together are a single license category, OSHPD data does not reflect the difference between them. Many of the hospitals providing adolescent inpatient psychiatric services also provide child services, and several hospitals utilize swing beds, which may be used for children or adolescents, depending on the demand. No facility offers inpatient child services without adolescent services. 20 13 57 24 35 86 15 76 Total Facilities 34 Total Beds 772 Total Counties With Child/Adol 34 247 12 14 Total Counties Without Child/Adol 44 89 Source: OSHPD 2014 data Updated October 11, 20 12
Acute Care Inpatient Psychiatric Bed Distribution Counties with Inpatient Beds for Gero-Psych Note: Gero-psych consists of medical care, nursing and auxiliary professional services and intensive supervision of the chronically mentally ill, mentally disordered or other mentally incompetent geriatric persons. Gero-psych patients must be diagnosed with a severe mental illness other than or in addition to diseases with organic origins such as Alzheimer s or dementia. 47 24 Total Facilities 2 Total Beds 71 Total Counties With Gero-Psych 2 Total Counties Without Gero-Psych 56 Source: OSHPD 2015 data Updated January 11, 2018 13
Acute Care Inpatient Psychiatric Bed Distribution Counties with Hospital-Based Chemical Dependency Beds 8 1 74 10 34 18 Total Facilities 22 251 Total Beds 670 Total Counties With CD 10 122 121 Total Counties Without CD 48 31 Source: OSHPD 2015 data Updated January 11, 2018 14