Adequacy of California's hospital infrastructural capacity for treating the mentally ill

In 1968, California began to implement policies making it more difficult to involuntarily hospitalize the mentally ill. This included closing state hospitals and reducing the number of community hospital inpatient psychiatric beds. California failed to support outpatient programs to compensate for these changes. The 2004 Mental Health Services Act provides funds to address some of these needs. This paper describes changes between 1990 and 2004 in California's structural capacity to serve the severely mentally ill during acute phases of their illness. It serves as a baseline to monitor the effects of the MHSA. Using data from hospital discharge abstracts, emergency department encounters and the annual report of hospitals we found a 50% drop in psychiatric beds per 100,000 population, a 38% decrease in substance abuse beds, a 51% drop in hospitals with any psychiatric beds, a 26% drop in emergency departments with psychiatric capacity, and a decrease of licensed psychiatrists with hospital privileges. Major geographic disparities emerged in the capacity of California counties and regions to serve this population, including a large increase in counties with no capacity. While these structural changes occurred, hospital admissions for mental illness remained about the same. Many acutely mentally ill are being hospitalized in general acute care beds in facilities with inadequate specialty coverage. These findings support the need for increasing mental health prevention and early intervention in community based programs and the need to improve the infrastructure to meet the needs of those requiring hospitalization during acute phases of their illness.