Over a period of 50 years, starting in the mid-1950s, the per capita number of psychiatric care beds in the United States decreased by 95 percent, from 680 beds per million residents in 1955 to 34 per million in 2005. Much of that decline is due to the closing of state asylums. In 1955, state psychiatric facilities cared for 560,000 patients. Today, they care for 45,000.
So, as our public healthcare system stopped caring for mental health patients, the police officers were given the brunt of responding to mental health issues. In 2017, law enforcement agencies spent $918 million transporting people with severe mental illness, according to a 2019 survey from the Treatment Advocacy Center. It also estimated that officers spend 21 percent of their time responding to and transferring people for mental health issues.
The hospitals also took on some care. The American College of Emergency Physicians found that 84 percent of emergency rooms said they board psychiatric patients, and it’s getting worse. More than 50 percent said they spend increasing time and energy trying to transfer those patients to appropriate psychiatric facilities.
Given all these problems, some health-care advocates have proposed a remedy that would have been unthinkable just a few years ago: returning to the traditional mental hospital, the very institution that reformers fought so hard to abolish in the 1960s. The Treatment Advocacy Center estimates that to reach a minimum level of psychiatric care, as many as 95,000 new beds would be necessary.
Critics will say that this is advocating a return to the inhumane treatments and overcrowded conditions portrayed in Ken Kesey’s famous book,One Flew Over the Cuckoo’s Nest. But we must try to imagine a new type of institution, one that would be a safe and caring refuge for mentally ill patients who were unsuited for community-based care. They wouldn’t be the asylums of the 1950s.
During our COVID-19 Pandemic, we have been moving to Telemedicine where a psychiatrist anywhere in the country can reach an initial diagnosis, prescribe medication and help the emergency room physicians decide whether the patient requires long-term psychiatric care somewhere else, or can return to the community in a few days. But our mental health system doesn’t just need psychiatrists, it needs beds. I believe it's imperative to see the underlying evidence all around us that demonstrates the mental health care system is in crisis too, and we must consider this when looking at real reforms for our communities going forward.