RESEARCH WEEKLY: Psychiatric Bed Availability and Suicide Risk By Elizabeth Sinclair Hancq Suicide is a significant public health problem. Suicide deaths per capita in the United States have been steadily increasing in the past 30 years with almost 45,000 individuals dying by suicide in 2020. Inpatient psychiatric care is an integral component of a full continuum of psychiatric care for individuals with severe mental illness, including those with increased risk for suicide. “Vital to reversing this suicide mortality trend is to be able to intervene with an individual at the right moment, which includes a greater capacity of psychiatric beds to take care of psychiatric emergencies and promote stabilization and recovery,” Dr. Steven Sharfstein and I wrote in an Op-Ed published in the Baltimore Sun in February 2020. New research published earlier this month in the British Medical Journal of Quality and Safety supports the importance of psychiatric bed availability to reduce suicide risk. Dr. Peter Kaboli and co-authors from The University of Iowa Roy J and Lucille Carver College of Medicine utilized Veterans Health Administration data to examine the association between psychiatric bed availability and veteran suicide risk across the Veteran’s Health Administration and at the individual hospital level. Specifically, the authors examined how bed occupancy rates, the average number of patients in the psychiatric hospital divided by the number of psychiatric beds, might impact suicide risk for veterans. The data suggests that high psychiatric bed occupancy rates are associated with an increased risk for suicide and that high psychiatric bed occupancy in Veterans Health Administration hospitals contributed to an estimated excess of 65 suicide deaths over a five-year period from 2011–2016. The authors examined psychiatric bed occupancy rates because they are a measure of psychiatric bed availability and related to how beds are used for psychiatric treatment. The authors posit that “a shortage of beds leading to high occupancy rates may contribute to increased suicide risk among patients if it leads to higher thresholds for psychiatric admission or decreased thresholds for treating patients in other settings.” For example, the same patient presenting to an emergency department with elevated suicide risk may be admitted to an inpatient bed if one is available but discharged home or transferred to community outpatient treatment with less psychiatric expertise if the inpatient beds are occupied. The authors found that Veteran hospitals with acute psychiatric bed occupancy higher than 95% were associated with a 10% increase in suicide risk compared to hospitals with lower than 85% occupancy. The Royal College of Psychiatrists recommend an occupancy of less than 85% to ensure timely access for admissions to an inpatient bed for those when they need it. The absolute number of psychiatric beds per capita nor amount spent on community mental health were associated with suicide risk, according to the results. “Inpatient psychiatric treatment is an important component of suicide prevention,” the authors write. “Hospitalization allows for identification and management of psychiatric and physical illnesses, coordination of care between providers and facilitation of access to support services, and provides time for personal or psychiatric crises to stabilize.” The Veterans Health Administration had a national average of 65.5 inpatient psychiatric beds per 100,000 veterans in 2016. This is almost three times the U.S. national average of 22 beds per 100,000 and more than five times more than the last remaining psychiatric beds in state psychiatric hospitals. In fact, many state psychiatric hospitals operate at a higher than 100% capacity. Based on the results from this research, it is important to examine how psychiatric bed occupancy may impact suicide risk in the general population and take the proper precautions to reduce occupancy rates in hospitals to ensure individuals have access to inpatient psychiatric treatment when they need it. References: Kaboli, P. J., et al. (2021). Association between acute psychiatric bed availability in the Veterans Health Administration and veteran suicide risk: A retrospective cohort study. BMJ Quality & Safety. Elizabeth Sinclair Hancq is the director of research at the Treatment Advocacy Center. View as Webpage To receive Research Weekly directly in your email inbox on a weekly basis, click here. Questions? Contact us at [email protected] Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. 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