In California, Merced, San Joaquin, and Stanislaus Counties sought to understand the gap between capacity and need for psychiatric and substance use disorder beds. This report estimates bed shortages by triangulating estimates through various data sets, literature review findings, and facility survey responses. The authors use these estimates to inform their recommendations to these counties for improving access to behavioral health care.

Cover: Psychiatric and Substance Use Disorder Bed Capacity, Need, and Shortage Estimates in California
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Psychiatric and Substance Use Disorder Bed Capacity, Need, and Shortage Estimates in California

Merced, San Joaquin, and Stanislaus Counties

by Jonathan S. Levin, Jonathan H. Cantor, Ryan K. McBain, 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 Merced, San Joaquin, and Stanislaus Counties?
  2. Does 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 waiting list 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.

California's Merced, San Joaquin, and Stanislaus Counties, like other counties throughout the United States, have 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 and 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 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 and adolescents and identified hard-to-place populations. The authors draw from these findings to offer Merced, San Joaquin, and Stanislaus Counties recommendations to help ensure all their residents, especially nonambulatory individuals, have access to the behavioral health care that they need.

Key Findings

Merced, San Joaquin, and Stanislaus Counties have a shortage of psychiatric inpatient beds for adults, but it is difficult to determine whether this shortage is among either acute or subacute beds

  • Across all co-occurring conditions that were surveyed, subacute facilities reported a higher rate of placing individuals with certain co-occurring conditions compared with acute care facilities.
  • Merced, San Joaquin, and Stanislaus Counties will need approximately 5 percent more adult psychiatric beds through 2026.
  • Children and adolescents in Merced, San Joaquin, and Stanislaus Counties are experiencing modest shortages of acute and subacute beds.

Merced, San Joaquin, and Stanislaus Counties had a modest surplus of SUD treatment beds for adults

  • Merced, San Joaquin, and Stanislaus had considerably lower SUD treatment bed capacity than both California and the United States more generally.
  • Fewer than half of SUD treatment facilities reported accepting patients with dementia, traumatic brain injury, a co-occurring intellectual disability, or a prior sex offense conviction.
  • Merced, San Joaquin, and Stanislaus Counties have a deficit of SUD treatment beds for children and adolescents.

Several populations were disproportionately hard to place in psychiatric and SUD treatment beds

  • The majority of psychiatric facilities stated that they were unable to place individuals with dementia, traumatic brain injuries, eating disorders, or those who required oxygen.
  • The majority of SUD treatment facilities stated that they were unable to place individuals with dementia, traumatic brain injuries, intellectual disabilities, or a prior sex offense conviction, as well as those who were incompetent to stand trial and those who are nonambulatory.
  • It is likely that individuals may find themselves stuck in one level of care when they would be more appropriately served in a different level of care — or entirely denied services.
  • High-need patients in Merced, San Joaquin, and Stanislaus Counties may be underserved and in need of new facilities with beds that specifically address their needs.

Recommendations

  • Focus on addressing the shortage of inpatient beds for psychiatric patients, especially for hard-to-place populations — including those with dementia and traumatic brain injuries.
  • Focus on increasing SUD treatment beds that are available for Merced, San Joaquin, and Stanislaus County residents who are currently hard to place — including nonambulatory individuals.
  • Track outcomes of investments in bed capacity over time, including bed occupancy rates, waiting list volume, and bottlenecks that inhibit transfers to higher and lower levels of care.

Research conducted by

The research described in this report was funded the California Mental Health Services Authority (CalMHSA) and conducted by RAND Health Care.

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