Cover: Adult Psychiatric Bed Capacity, Need, and Shortage Estimates in California—2021

Adult Psychiatric Bed Capacity, Need, and Shortage Estimates in California—2021

Published Jan 18, 2022

by Ryan K. McBain, Jonathan H. Cantor, Nicole K. Eberhart, Shreya S. Huilgol, Ingrid Estrada-Darley

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Research Questions

  1. What are the levels of care represented by psychiatric bed infrastructure?
  2. What will be the estimated need for psychiatric beds in the period from 2021 to 2026?
  3. What are the primary drivers of California's psychiatric bed shortage?
  4. Where is the greatest need among levels of care throughout the state?
  5. What factors contribute to bottlenecks and flow issues in the psychiatric bed infrastructure?

Psychiatric beds are essential infrastructure for meeting the needs of individuals with mental health conditions. However, not all psychiatric beds are alike: They represent infrastructure within different types of facilities, ranging from acute psychiatric hospitals to community residential facilities. These facilities, in turn, serve clients with different needs: some who have high-acuity, short-term needs and others who have chronic, longer-term needs and may return multiple times for care. California, much like many parts of the United States, is confronting a shortage of psychiatric beds. In this report, the authors estimated California's psychiatric bed capacity, need, and shortages for adults at each of three levels of care: acute, subacute, and community residential care. They used multiple methods for assessing bed capacity and need in order to overcome limitations to any single method of estimating the potential psychiatric bed shortfall. The authors identified statewide shortfalls in beds at all levels of inpatient and residential care. They also documented regional differences in the shortfall and identified special populations that contributed to bottlenecks in the continuum of inpatient and residential care in the state.

Key Findings

The magnitude of California's need for adult psychiatric beds is expected to grow modestly over the next five years

  • California faces an estimated 1.7-percent growth in its psychiatric bed need from 2021 to 2026.
  • California's adult psychiatric bed capacity varies by region and by level of care.
  • Growth in the need for psychiatric beds is projected to be largest in the Northern and Southern San Joaquin Valley.

California faces shortages of psychiatric beds at all three major levels of adult inpatient and residential care

  • Synthesizing findings for bed capacity and bed need, the authors estimated that the state has a shortfall of approximately 1,971 beds at the acute level (6.4 additional beds required per 100,000 adults) and a shortage of 2,796 beds at the subacute level (9.1 additional beds required per 100,000 adults)—or 4,767 subacute and acute beds combined, excluding state hospital beds. Separately, the state faces an estimated shortage of 2,963 community residential beds.
  • The authors noted significant regional differences in the estimated shortfall of beds at each level of care.

Hard-to-place populations contribute disproportionately to bottlenecks in the existing system

  • A majority of psychiatric facilities at all levels of care reported an inability to place individuals with comorbid dementia or traumatic brain injury, nonambulatory individuals, those requiring oxygen, and those who tested positive for COVID-19. Individuals involved in the criminal justice system—particularly those with arson or sex offense convictions—were reportedly difficult to place in community residential settings.


  • California officials should prioritize psychiatric bed infrastructure where need is greatest, considering shortfalls according to both geographic region and level of care.
  • California officials should focus on building or remodeling infrastructure for the most hard-to-place populations, such as those with criminal justice involvement who are unable to step down from subacute to community residential settings because of a lack of facilities that can accommodate them at the lower level of care.
  • California officials should consider establishing a mechanism by which psychiatric facilities report periodically on bed occupancy rates, wait list volume, number of requested transfers to higher and lower levels of care, psychiatric patient boarding in emergency departments, and sociodemographic and clinical information on patients who utilize psychiatric beds. This would allow California to have a precise and sensitive system for tracking the impact of investments that seek to address psychiatric bed shortages.

Research conducted by

This research was funded by the California Mental Health Services Authority and carried out within the Access and Delivery Program in RAND Health Care.

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