Minimum and optimal numbers of psychiatric beds: expert consensus using a Delphi process

Abstract

The required minimum number of psychiatric inpatient beds is highly debated and has substantial resource implications. The present study used the Delphi method to try to reach a global consensus on the minimum and optimal psychiatric bed numbers. An international board of scientific advisors nominated the Delphi panel members. In the first round, the expert panel provided responses exploring estimate ranges for a minimum to optimal numbers of psychiatric beds and three levels of shortage. In a second round, the panel reconsidered their responses using the input from the total group to achieve consensus. The Delphi panel comprised 65 experts (42% women, 54% based in low- and middle-income countries) from 40 countries in the six regions of the World Health Organization. Sixty psychiatric beds per 100 000 population were considered optimal and 30 the minimum, whilst 25–30 was regarded as mild, 15–25 as moderate, and less than 15 as severe shortage. This is the first expert consensus on minimum and optimal bed numbers involving experts from HICs and LMICs. Many high-income countries have psychiatric bed numbers that fall within the recommended range. In contrast, the number of beds in many LMIC is below the minimum recommended rate.

Specialised psychiatric beds and 24-hour residential care in Australia 2018–2019 – Comparative analysis and commentary according to international benchmarking

“…Mundt et al 3 recently conducted an international Delphi study (67 experts, 44% women, 52% in low to middle-income countries) across 40 countries to determine what was regarded as the global consensus on minimal and optimal psychiatric hospital bed numbers, excluding 24-h staffed community residential care beds. The minimum level of psychiatric beds per 100,000 population was regarded as 30.…”

“…Exclusive of 24-hour-staffed community residential beds, Australia’s total psychiatric bed numbers are much lower than the consensus optimal level of 60 hospital psychiatric beds per 100,000 population. 3 Over the period 2014–15 to 2018–19, there has been a substantial decline in Australian public non-acute and 24-hour-staffed residential care beds across most states and territories. This indicates a reduced capacity for non-acute care.…”

Changes in rates of psychiatric beds and prison populations in sub-Saharan Africa from 1990 to 2020

“…Furthermore, the capacity in facilities of poorly-resourced settings does not necessarily indicate that the beds are available for acute care due to the lack of human resources (0.9 mental health practitioners per 100 000) [ 2 ] or funds to run the facilities, as was reported for Guinea-Bissau. A worldwide expert consensus process including experts from the African region defined less than 15 beds per 100 000 population as severe shortage and recommended a minimum number of 30 per 100 000 population [ 43 ]. Experts from African countries usually argue to increase psychiatric bed numbers [ 44 ].…”

Penumbra of the pandemic workplace for psychiatrists and trainees in Australia

“…However, the baseline levels of specialised mental health beds across public and private sector 19 remain low by world consensus standards. 20 Expansion of private hospital bed capacity has partially compensated for the decline in bed numbers for public sector services. 19 Steady emergency and specialised bed demands were within these limited resources.…”