Access to Pediatric Inpatient Psychiatric Care Hasn’t Met Growing Demand

Despite the growing mental heath crisis among kids, pediatric inpatient psychiatric bed capacity remained unchanged from 2017 to 2020, and the number of beds varied widely by state, a cross-sectional study showed.

Looking at more than 6,000 hospitals, there was no significant change from 2017 to 2020 in hospitals with pediatric inpatient psychiatric beds (398 vs 400, P=0.78) or national pediatric inpatient psychiatric bed capacity (11,107 vs 11,276, P=0.70), reported Anna Cushing, MD, of Children’s Hospital Los Angeles, and co-authors.

Of note, most hospitals with pediatric inpatient psychiatric beds were located in urban areas (355 of 400), representing 91.3% of bed capacity, they wrote in JAMA Pediatrics.

“The findings from this work highlight the importance of ensuring that all children have access to high-quality mental health care, regardless of where they live,” Cushing told MedPage Today.

The median number of pediatric inpatient psychiatric beds per 100,000 children across states was 15, ranging from zero beds in Alaska to 75 in Arkansas.

“We already know from prior studies that many areas of the U.S. have shortages of outpatient pediatric mental healthcare, particularly in rural areas,” Cushing said. “Our research shows these geographic differences exist for pediatric inpatient psychiatric care as well.”

“This means that many children who require inpatient psychiatric hospitalization may need to transfer long distances to access care,” she added.

These findings are in line with recent research that showed that roughly half of young patients who boarded in the emergency department awaiting inpatient psychiatric care were never admitted to such a facility.

Jacob Ballon, MD, MPH, of Stanford University in California, who was not involved in the study, explained that these findings reveal a troubling situation for pediatric mental healthcare across the country.

“The trend towards a stable amount of inpatient pediatric psychiatry beds from 2017-2020 is concerning, as the population increases overall and the number of children who may need acute care has also increased,” Ballon told MedPage Today.

Still, he noted that this research did not factor in the resources for pediatric and adolescent outpatient programs, which may account for the discrepancy in some states and regions of the country.

“When working with young people, there is greater overall emphasis on outreach and prevention, which is more associated with outpatient treatments, and thus looking only at inpatient beds may neglect those types of investments in many states,” he said.

For this study, Cushing and colleagues looked at 6,347 hospitals from the 2017-2020 American Hospital Association Survey Database, 421 of which had at least two pediatric inpatient psychiatric beds during this time.

The authors noted that pediatric inpatient psychiatric beds were offered most frequently at nonprofit and general medical hospitals. Of 11,276 beds, 52.2% were in free-standing psychiatric hospitals (34.9% at general psychiatric hospitals and 17.3% at children’s psychiatric hospitals), and 23% of beds were in hospitals specializing in pediatric care.

Higher statewide median household income (r = -0.42, P=0.003) and a higher percentage of Hispanic population (r = -0.37, P<0.009) were associated with fewer beds per capita. The percentage rural population (r=0.21, P=0.15), percentage minority racial groups (r = -0.16, P=0.28), and Medicaid expansion status (Wilcoxon rank sum, P=0.34) were not associated with beds per capita.

The study was limited by the use of self-reported data in the American Hospital Association database and the inability to assess need for inpatient services using this data source.

“Further research will be needed to quantify how many pediatric inpatient psychiatric beds are needed to meet demand,” Cushing said. “Additionally, we need to understand whether the geographic variation we identified leads to worse outcomes for children living in areas with fewer pediatric inpatient psychiatric beds.”

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