Inpatient psychiatric care has dramatically shifted to large for-profit chains, according to new research from Columbia University Mailman School of Public Health and Johns Hopkins Bloomberg School of Public Health. The researchers found that the total number of inpatient psychiatric beds barely changed from 2011 to 2023. But behind the stable headline figure lies a dramatic shift: a decline in beds at general hospitals offset by a rise in beds at standalone psychiatric facilities-particularly those owned by large for-profit chains.
Until now there was limited research on recent developments in the psychiatric bed supply. The findings were published in JAMA Psychiatry.
Over the 12-year period, the share of psychiatric beds in standalone facilities that provide only psychiatric care rose from 65 percent to 74 percent. A shift also occurred in the ownership of those standalone facilities. In 2011, just 11 percent of standalone psychiatric facility beds were owned by large for-profit chains. By 2023, the share had grown to 27 percent. Meanwhile, government-owned beds declined from 64 percent in 2011 to 48 percent in 2023.
"Psychiatric beds are increasingly located in hospitals that only provide psychiatric care, and those hospitals are more likely than ever to be owned by large for-profit chains," said Adam Sacarny, PhD, associate professor of Health Policy and Management at Columbia Mailman School and last author.
"There may be benefits to patients of more care being delivered at specialized hospitals, but there have also been reports of safety and quality-of-care concerns at some large chains. These developments therefore merit careful study to ensure patients receive high-quality psychiatric care," noted Karen Shen, PhD, the study's corresponding author and Assistant Professor of Health Policy and Management at Johns Hopkins Bloomberg School.
To assess these trends, researchers analyzed 2011-2023 data from the Healthcare Cost Report Information System (HCRIS), identifying freestanding psychiatric hospitals and categorizing them by ownership type, including large for-profit chains-defined as groups operating at least 15 hospitals. The analysis also used data from the American Hospital Association's Annual Survey.
The findings indicate that the growth of for-profit chains is ongoing, and thus likely not merely a response to policies like the Affordable Care Act or federal mental health parity legislation which were passed in the early 2010s. Instead, it represents a broader shift in how psychiatric care is delivered.
In addition to Shen and Sacarny, the study's co-authors include Mark Olfson, MD, MPH of Columbia University Mailman School of Public Health and Columbia Psychiatry.
