Bed Check: Inpatient Psychiatric Care in Three California Counties

Mathematica Policy Research


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In June 2018, San Diego’s Tri-City Medical Center announced it would eliminate 30 inpatient psychiatric beds — including an 18-bed locked behavioral health unit and a 12-person crisis-stabilization unit. This closure is part of a 25-year reduction in California’s supply of inpatient psychiatric beds, during a time when demand for mental health care services across the state has been increasing. In response to these developments, an investigation was conducted into the factors contributing to the availability of and demand for inpatient psychiatric care in the state. The findings are discussed in Bed Check: Inpatient Psychiatric Care in Three California Counties.

Bed Availability in San Diego, Fresno, and Contra Costa Counties

The research looked in depth at three California counties — San Diego, Fresno, and Contra Costa — which represent geographically diverse regions of the state and vary in key demographic characteristics. For example, Contra Costa County has a relatively low share of residents covered by Medi-Cal and a low share of residents living in poverty compared with the state average. By comparison, Fresno County has a relatively high share of residents living in poverty and a high percentage of residents covered by Medi-Cal. San Diego County was selected in part because of the urgency generated by the closure of the Tri-County Medical Center’s psychiatric units.

Assessing the availability of and need for inpatient beds requires an understanding of the system as a whole. Inpatient services represent one modality in a complex, interconnected system of care for mental health conditions. People with mental health needs also engage with providers in emergency settings, as well as in routine outpatient environments such as primary care and mental health clinics. Patients may also use intensive outpatient settings, such as partial hospitalization or assertive community treatment programs, which function as intermediary care between inpatient and routine outpatient care.

Importantly, when patient throughput — their flow across the mental health system — is obstructed by a lack of access at one or more of these different points of care, the effects may be felt throughout the system.

The purpose of this research is to provide information on the availability and use of inpatient psychiatric services in the context of related factors.

About the Authors

Amanda Lechner, MPP, is a health researcher at Mathematica. Also with Mathematica are Matthew Niedzwiecki, PhD, health researcher; Megan Dormond, MSW, health analyst; Jasmine Little, MA, health analyst, and Melissa Azur, PhD, associate director of health.

Working at the intersection of strategy, evaluation, and practice, Mathematica helps maximize the impact of foundation investments, ensuring they are evidence-informed and move the needle on complex challenges. We offer learning and evaluation services to strengthen program design and execution across the strategy lifecycle. For more information, visit www.mathematica.org.