Psychiatric Bed Levels

Alan Gordon, MB, BChir, FRCPC (1)

This paper was approved by the Canadian Psychiatric Association Board of Directors on March 20, 1997.

The Canadian Psychiatric Association (CPA) subscribes to the following principles in determining the need for inpatient psychiatric beds:

Overriding Principles

1. The decision as to whether a person suffering from a mental disorder should be treated in a hospital or not is strongly influenced by the social climate of the community and the availability of alternatives. It is therefore impossible to make categorical statements regarding the number of psychiatric inpatient beds needed, and local circumstances must always be taken into account.

2. The most important factor for psychiatry is the nature of treatment programs rather than where treatment occurs. Jurisdictions that have focused primarily on where care and treatment occur, rather than on the nature and quality of the care and treatment offered, have experienced community neglect of many persons suffering from severe mental illnesses.

Guiding Principles in Determining the Need for Adult Acute Care Psychiatric Beds

3. The advantages of treating the acutely mentally ill in a hospital include access to expert personnel, appropriate diagnostic facilities, and an atmosphere of relative safety. These advantages are reduced if a lack of beds causes such a concentration of severely ill persons that the level of disturbance becomes too high.

4. Studies suggest that up to 40% of acutely mentally ill persons presenting for admission to a hospital can be managed in alternative care settings, including purpose-built day hospital or intensive ambulatory care facilities. The CPA supports the development of alternative treatment settings.

5. Until recently, there appeared to be a consensus among planners that there was a need for approximately 0.5 adult acute psychiatric beds per 1000 population, assuming adequate backup community resources. This ratio was confirmed by utilization data in most jurisdictions. Experience has demonstrated that attempts to reduce the number of beds in this ratio or to function without adequate community resources lead to the substitution of more expensive general medical beds.

6. Recently, planners have been setting targets lower than the 0.5 beds:1000 population ratio with little evidence that psychiatric services can manage at the lower levels and with mixed results. The CPA advises caution in setting these low targets and would emphasize the importance of taking into account the local situation using sound criteria and methods in assessing needs, including local prevalence and incidence as well as the availability of appropriate community resources and alternative care settings.

7. Since different jurisdictions in Canada define psychiatric beds differently, any measures of met-need should specify the types of beds that are included.

Other Needs

8. The CPA recognizes that there is a need for appropriate and adequate community psychiatry programs which complement the need for adequate numbers of inpatient psychiatric beds.

9. Additional resources are required for meeting the long-term treatment needs of the severely or chronically mentally ill. In this regard, a guideline of 0.15 high-dependency places per 1000 population is generally accepted and would be supported by the CPA depending on local circumstances.

10. Distinct and additional inpatient resources are required for Forensic, Geriatric, and Child and Adolescent Psychiatry.

(1) Medical Director, Alberta Hospital, Edmonton, Alberta

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