DENVER — Helen Santoro, an author, was placed on an involuntary 72-hour mental health hold at a crisis clinic near Denver in April after a social worker determined she was an imminent danger to herself. Santoro remained overnight at the clinic because area hospitals with inpatient psychiatric units did not have available beds.

The number of hospitals with inpatient psychiatric units dropped from 2011 to 2023. A 2025 study found the United States has 28.4 inpatient psychiatric beds per 100,000 people, below the 60 beds per 100,000 that researchers frequently consider optimal. The American Psychiatric Association has described the shortage as a crisis. Due to bed shortages, acutely ill individuals are left without critical care, emergency rooms are overwhelmed with people experiencing severe mental health illnesses, and inpatient stays are shortened to expedite bed turnover.

The number of psychiatric beds in the U.S. peaked at more than half a million in 1955. Many state hospitals closed following the introduction of antipsychotics, concerns about humane treatment, and the passage of the Community Mental Health Act, which President John F. Kennedy signed in 1963. A policy enacted two years later restricted federal Medicaid funds from covering inpatient psychiatric care in facilities with more than 16 beds to encourage a transition to community-based care.

Zoe Lindenfeld, an assistant health policy professor at Rutgers University and co-author of the 2025 studies on psychiatric bed shortages, asked, "Where are these people going?" She added, "For people who don't receive this care, they don't just go away." Leslie Carpenter, legislative advocacy manager at the Treatment Advocacy Center, said, "The road to hell is paved with good intentions." Carpenter stated, "A lot of these bills, including the Community Mental Health Act, were really well intended and ended up with adverse consequences."

An estimated 61,000 inpatient psychiatric beds for adults and children remain in the United States, while more than 14 million people experience severe mental illness annually. Mental health expenditures rose from $32 billion in 1986 to $186 billion in 2014, though the proportion allocated to inpatient care decreased from 42% to 27% during that period. The U.S. Supreme Court's 1999 decision in Olmstead v. L.C. mandated states provide home and community-based services, shifting care away from psychiatric facilities.

Last year, members of Congress introduced the Repealing the Institution for Mental Diseases Exclusion Act and the Michelle Alyssa Go Act to modify the 16-bed Medicaid funding cap, with the latter proposing an increase to 36 beds. Both efforts have stalled in the House. The Congressional Budget Office estimated eliminating the limit would increase Medicaid expenditures by $33.5 billion from 2024 to 2033. Colorado, along with 15 other states and Washington, D.C., utilizes waivers permitting Medicaid to fund facilities with more than 16 beds, while seven additional states have pending waivers.