Since the 1800s, every state government has operated a psychiatric hospital with inpatient beds for individuals who require intensive treatment in an inpatient setting. Since the 1950s, when state hospital populations peaked at over 550,000 residents, states have been downsizing by closing beds or shuttering entire hospitals and shifting care of individuals with serious mental illness (SMI) to community-based services. In 2025, for the first time since the 1950s, more states are increasing their state psychiatric hospital capacity by reopening beds in existing state hospitals or even building new state psychiatric hospitals to care for individuals needing the most intensive psychiatric care.
Shortages of Psychiatric Beds
Having an adequate supply of psychiatric inpatient beds remained a growing issue that states addressed in 2024. In 2002, when NRI first collected information about shortages of psychiatric beds, 50 percent of states reported a shortage; however, in 2025, that has increased to 90 percent of responding states (43 of 48 states). Psychiatric beds to treat forensic clients was the most frequently cited bed shortage (37 states). Thirty-eight states reported a shortage of psychiatric inpatient beds in non-state hospitals, with 28 states experiencing shortages of acute psychiatric beds, and 19 states reporting shortages of longer- term psychiatric beds in non-state hospital settings.