45.1 CHILD AND ADOLESCENT PSYCHIATRY INPATIENT HOSPITAL CAPACITY IN THE UNITED STATES: UNDERSTANDING OUR CURRENT STATE

Abstract

Objectives: In communities across the United States, large numbers of children and adolescents with acute psychiatric presentations are being held for days and weeks in emergency departments and pediatric medical units, awaiting placement for inpatient psychiatric hospital treatment. These settings are not designed to safely and effectively care for these children. The prolonged waiting is usually attributed to an inadequate supply of beds, and the solution seems self-evident: build more beds. This simple statement belies the complexity of determining the adequate number of beds for a given community, a number dependent on a variety of factors including the epidemiology of children’s mental illness, social determinants of health, the functioning of other mental health services, and the availability of community supports. The aim of this session is to provide a detailed background of the scope of our inpatient access problem and its consequences. Methods: Available state and national data will be reviewed and synthesized to describe the availability and distribution of inpatient child and adolescent psychiatry hospital beds. The impact of the limitation in beds on children and adolescents and families as well as healthcare systems will be described. The needs of special populations and the clinical profiles of patients most likely to experience prolonged boarding will be reviewed. As a case example, the efforts of state regulators in Massachusetts to address this problem will be described. Results: Boarding of children and adolescents with acute mental illness has been associated with scarcity and maldistribution of inpatient beds and is highly prevalent and widespread across the United States. The problem appears to have been severely exacerbated during the SARS-CoV-2 pandemic. Conclusions: Boarding of children in emergency departments is associated with elevated safety risks, poor clinical quality, poor patient experience, disruption of nonpsychiatric emergency services, and excessive costs. In order to address this issue, state and local policymakers need tools to determine the number and types of children’s psychiatric inpatient units needed for their communities. ICP, CC, PUP