Trend analysis of inpatient mental health capacity in Pennsylvania 1990 - 2006

Objective: The downsizing and closure of state psychiatric hospitals has prompted concerns about the adequacy of resources available to ensure the safe transition and recovery of individuals with psychiatric disorders in the community. This study examined inpatient treatment capacity for psychiatric disorders in Pennsylvania over 16 years (1990 – 2006). Methods: A longitudinal descriptive analysis of the number of state hospital, acute and sub-acute community hospital beds, community residential rehabilitation beds, discharges, and per capita mental health expenditures from public sources such as Medicaid and state block grant funds by region and county was performed. Results: Our findings showed that despite a 29% decline in psychiatric beds (state hospital, general and specialty hospitals) and a 33% decrease in length of stay (15 to 10 days), discharges from acute care psychiatric beds increased by 32% as a result of more people being hospitalized. Annual readmissions to acute care hospitals rose only slightly from 1.3 per person in 1990 to 1.4 in 2006. We observed a 68% decrease in admissions for substance abuse and twice as many admissions for affective disorder over the 16-year period as well as an average increase in Emergency Room admissions to 50%. Conclusions: The trends in inpatient psychiatric beds in Pennsylvania are comparable to the US in general. Psychiatric beds and LOS have decreased but there is no evidence to show a revolving door syndrome or extraordinary high occupancy rates on average although there is great variability in capacity, especially in the Southern part of the state.