Regional changes in inpatient psychiatric bed capacity and availability of alternative psychiatric services, 2012-2022.

Introduction: The US faces a growing mismatch between demand for inpatient psychiatric care and available capacity. Little is known about the characteristics of regions affected by inpatient psychiatric bed shortages, which hospitals have faced decreases in bed supply, and whether other psychiatric services have emerged to fill the gap. Methods: Using data from the American Hospital Association Annual Survey, we conducted a descriptive analysis of inpatient psychiatric bed supply across hospital referral regions (HRRs) from 2012 to 2022. We examined the demographic patterns of regions affected by shortages, assessed hospital characteristics associated with reductions in psychiatric capacity, and evaluated the presence of alternative psychiatric services that may substitute for inpatient care. Results: More than 60% of the US population consistently lived in HRRs with psychiatric bed shortages during this period, defined as fewer than 30 beds per 100 000 people. By 2022, HRRs with severe shortages, relative to those without them, were more likely to be in the West and had higher proportions of Hispanic residents, raising concerns about inequities in behavioral health care access. Hospitals most likely to reduce psychiatric capacity were general, non-profit, and system-affiliated institutions with lower total margins. Importantly, hospitals in severe shortage areas were less likely to have outpatient psychiatric services, indicating that alternative hospital-based resources may not fully offset inpatient shortfalls. Conclusion: Addressing the nation's psychiatric bed shortage will require targeted financial support for general hospitals at risk of closing psychiatric units and investment in broader psychiatric infrastructure to ensure equitable access across regions.