Psychiatric and Substance Use Disorder Bed Capacity, Need, and Shortage Estimates in Sacramento County, California

by Ryan K. McBain, Jonathan H. Cantor, Nicole K. Eberhart, Christina Crowley, Ingrid Estrada-Darley

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Research Questions

  1. What is the current capacity of psychiatric and SUD treatment beds in Sacramento County?
  2. Does county capacity meet residents' needs for mental health and SUD treatment?
  3. How many treatment beds would be required to maintain a functional bed occupancy rate, as well as accommodate waitlist volume and requested transfers to higher or lower levels of care?

Psychiatric and substance use disorder (SUD) treatment beds are essential infrastructure for meeting the needs of individuals with behavioral health conditions. However, not all psychiatric and SUD beds are alike: They represent infrastructure within different types of facilities. For psychiatric beds, these vary from acute psychiatric hospitals to community residential facilities. For SUD treatment beds, these vary from facilities offering short-term withdrawal management services to others offering longer duration residential detoxification services. Different settings also serve clients with different needs. For example, some clients have high-acuity, short-term needs; others have longer-term needs and may return for care on multiple occasions.

Sacramento County, like other counties throughout the United States, has sought to assess shortages in psychiatric and SUD treatment beds. In this report, the authors estimated psychiatric bed and residential SUD treatment capacity, need, and shortages for adults and children/adolescents at various levels of care: acute, subacute, and community residential services for psychiatric treatment and SUD treatment service categories defined by American Society of Addiction Medicine (ASAM) clinical guidelines.

Drawing from various data sets, literature review findings, and facility survey responses, the authors computed the number of beds required—at each level of care—for adults and children/adolescents and identified hard-to-place populations. The authors draw from these findings to offer Sacramento County recommendations to help ensure all its residents, especially Medi-Cal recipients, have access to the behavioral health care that they need.

Key Findings

Sacramento County requires greater capacity for both psychiatric and SUD treatment beds

  • Compared with facility survey responses, licensure data appear to overestimate psychiatric bed capacity by approximately 23 percent (as a result of closures).
  • Sacramento County's capacity of psychiatric and SUD treatment beds fell short of statewide and national reference benchmarks.

Although some facilities appear to have stable bed occupancy rates and short waitlist volumes, beds at these facilities are not available to many individuals in need of services

  • In terms of psychiatric beds, this need is particularly urgent at lower levels of care; for SUD treatment beds, urgency of need is most pronounced for Sacramento County residents who are insured by Medi-Cal.
  • Among SUD treatment beds, there is greater demand for higher-intensity services: Beds for ASAM levels 3.5 and 3.3 had higher occupancy rates, and requests for transfers to higher levels of care outnumbered requests for transfers to lower levels of care.
  • Sacramento County will need just shy of 3 percent more adult psychiatric beds through 2026.

Shortfalls in capacity offset surpluses, and out-of-county placements contribute to patients jockeying for a limited number of spaces

  • Aligning its need for SUD treatment beds on statewide or national reference benchmarks, Sacramento County would fall short by more than 100 SUD treatment beds for adults and another 30 to 40 beds for children/adolescents.
  • More than one-quarter of SUD treatment beds were occupied by clients from outside Sacramento County, and more than one-half of facilities did not accept Medi-Cal patients.

Recommendations

  • Focus on addressing the shortage of psychiatric beds at lower levels of care and for difficult-to-place populations—including those with comorbid dementia.
  • Focus on SUD treatment beds that are available for Sacramento County residents who are currently difficult to place—including Medi-Cal recipients.
  • Consider the comparative needs of children/adolescents and adults, as well as the comparative quality of underlying information for both. Quality of information was particularly poor for children/adolescents.
  • If Sacramento County were to expand bed capacity, it should track outcomes of these investments over time—including bed occupancy rates, waitlist volume, and bottlenecks that inhibit transfers to higher and lower levels of care—to know if investments are paying off.

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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