Assessing the Optimal Number of Psychiatric Beds for a Region

Psychiatric Crisis Care and the More is Less Paradox

Psychiatric crisis care in the U.S. exemplifies the "more is less paradox" of U.S. health care. We spend more for health care than any other high-income country, yet our outcomes are typically poor compared to these other countries (OECD in OECD health statistics. Retrieved from https://www.oced.org/health/health-data.html , 2020). We do this, in part, by emphasizing medical treatments for problems that are inherently social, rather than addressing social determinants of health. Medical interventions for socio-economic problems are usually expensive and ineffective. For mental health crisis care, adding unfunded, untested, medical interventions to the current mélange of poorly funded, disorganized arrangements will not help. Instead, the U.S. should address social determinants, emphasize research-based interventions, and emphasize prevention-proven strategies that decrease costs and improve outcomes.

National levels of human development and number of mental hospital beds

AIMS

The number of mental hospital beds per population varies widely across countries, and the reasons for this variation are not fully understood. Given that differences in disease prevalence do not explain variation in inpatient mental health care availability, we examined the relationship between mental hospital beds and national income, education and longevity as measured by the Human Development Index (HDI).

METHODS

We used an international dataset of social, economic and structural measures to conduct a mixed-effects longitudinal regression of predictors of the number of mental hospital beds per 100 000 in the overall population for 86 countries for years 2005-2015.

RESULTS

Our initial dataset contained 1881 observations consisting of 11 years of potential measurements across 171 countries. After eliminations based on missing data and subsequent imputation, the dataset for the final regression model included 946 observations over 86 countries. The primary predictors of a country's number of mental hospital beds were year, HDI and GINI coefficient, the latter being a measure of income disparity. Holding all other factors constant, the number of beds decreased 8% per year, reflecting the ongoing international trend of deinstitutionalisation. As hypothesised, higher HDI predicted more mental hospital beds. Every 0.1 increase in HDI (0-1.0) was associated with a 126% increase in the number of hospital beds at the sample's mean GINI index score of 38 (0-100). However, a strong interaction between HDI and the GINI coefficient indicated that a high level of income disparity attenuated the positive association between HDI and mental hospital beds. At a GINI index score of 48, every 0.1 increase in HDI was associated with a 71% increase in the number of hospital beds.

CONCLUSIONS

As countries reduce the number of hospital beds over time, higher levels of economic disparity are associated with a reduction in the strength of the association between national prosperity and investment in mental hospitals. As power becomes increasingly concentrated, perhaps those with the least are more easily forgotten.