Eight days before my 33rd birthday in April, a social worker at a crisis clinic near Denver determined I was an imminent danger to myself. She placed me on an involuntary 72-hour mental health hold.
What came next wasn鈥檛 treatment, but a search for a bed. Clinic staffers called area hospitals with inpatient psychiatric units, asking if they had available beds. They didn鈥檛. So, I was told I had to spend the night at the clinic, which is open 24/7. I settled into a recliner, trying to make myself comfortable as my mind drifted in a blank, disassociated haze. Sleep came in brief bursts.
Since the 1950s, the United States has seen a dramatic decline in the number of psychiatric beds nationwide due in part to deinstitutionalization and the rise of antipsychotics. But that has created a critical shortage for those needing help. From 2011 to 2023, the number of hospitals with inpatient psychiatric units dropped significantly, according to a 2025 study. Another study from that year found that this country has 28.4 inpatient psychiatric beds per 100,000 people — not even half the 60-bed ratio researchers frequently refer to as the optimal level.
The shortage has created what the American Psychiatric Association calls a crisis: emergency rooms overwhelmed with people suffering from severe mental health illnesses, inpatient stays prematurely shortened to speed up bed turnover, and acutely ill individuals left without critical care.
鈥淲here are these people going?鈥� said Zoe Lindenfeld, an assistant health policy professor at Rutgers University, who co-authored those 2025 studies. 鈥淔or people who don鈥檛 receive this care, they don鈥檛 just go away. How is it affecting them? Society? Their families?鈥�
Meanwhile, the White House shut down the part of the national suicide hotline catering to LGBTQ+ youth, President Donald Trump鈥檚 2027 budget proposal calls for cuts to agencies engaged in mental health work, and Health and Human Services Secretary Robert F. Kennedy Jr. recently announced a plan to reduce the 鈥渙veruse of psychiatric medications.鈥�
A fractured system
I was already intimately familiar with the country鈥檚 fractured mental healthcare system before I was involuntarily committed. What I had yet to experience myself, I saw through my wife: waitlists, outpatient programs stretched beyond capacity, and inpatient psychiatric care so scarce that access often depends on surviving a crisis severe enough to justify it.
She died by suicide after we had separated.
As the years passed, grief and anxiety pushed me from observer to patient.
At the crisis clinic, I woke up the following morning disoriented and groggy. In the bathroom — its door deliberately unable to latch, swinging both ways so staffers could enter in case of an emergency 鈥� I stood at the sink and watched the faucet run, trying to piece together how I had ended up here.
America鈥檚 history of treating mental illness is long and complicated.
The 19th and 20th centuries saw the removal of people with severe mental disorders from jails and poorhouses — squalid facilities designed to house the poor 鈥� to state asylums that promised 鈥渕oral treatment鈥� (though they ultimately became overcrowded hospitals for the impoverished). From the 1860s to the 1930s, the number of psychiatric hospitals increased dramatically, according to the American Psychiatric Association, and by 1955, the number of psychiatric beds in the U.S. peaked at more than half a million.
However, owing to the development of antipsychotics, the belief that psychiatric institutions were inhumane, and President John F. Kennedy鈥檚 1963 Community Mental Health Act to free thousands of Americans from a life in institutions, many state hospitals shut down. An estimated 61,000 inpatient psychiatric beds for adults and kids are left in a country where more than 14 million experience severe mental illness each year.
Two years after JFK鈥檚 legislation passed, a new policy prohibited federal Medicaid funds from covering inpatient psychiatric care in facilities with more than 16 beds. The goal was to encourage states to move patients out of large, often substandard psychiatric institutions into community-based care settings.
The consequences of these changes, however, have been far-ranging. People with severe mental illnesses are often forced to board in emergency departments as they wait for a bed to open. The length of stay in state psychiatric hospitals is shrinking while readmission rates rise, according to research by the Treatment Advocacy Center, a national organization focused on eliminating barriers to the treatment of severe mental illness. And some people with mental illness languish for months, or even years, in jail.
From 1986 to 2014, as the behavioral health crisis intensified, mental health expenditures in the U.S. rose from $32 billion to $186 billion — though the proportion of that spending allocated to inpatient care fell from 42% to 27%.
This period also recorded major policy shifts affecting inpatient hospitalization rates, notably the 1999 U.S. Supreme Court decision in Olmstead v. L.C. The ruling shifted care away from psychiatric facilities by mandating states provide home and community-based services to people with developmental and mental disabilities.
鈥淭he road to hell is paved with good intentions,鈥� said Leslie Carpenter, legislative advocacy manager at the Treatment Advocacy Center. 鈥淎 lot of these bills, including the Community Mental Health Act, were really well intended and ended up with adverse consequences.鈥�
For me, that next day at the clinic passed both painfully slowly and in a blur. A staff member I hadn鈥檛 met before told me they were still reaching out to hospitals across the region. The search for a bed continued.
鈥楴o One Wants To Pay for Any of This Care鈥�
Last year, Congress introduced two federal bills to change the 16-bed Medicaid funding cap at inpatient psychiatric facilities, including the Repealing the Institution for Mental Diseases Exclusion Act and the Michelle Alyssa Go Act, which would increase the cap to 36 beds. Both have stalled in the House.
According to the Congressional Budget Office, a federal agency that analyzes budgetary and economic issues, eliminating the 16-bed limit would increase Medicaid expenditures by $33.5 billion from 2024 to 2033.
鈥淣o one wants to pay for any of this care that people need,鈥� said state Sen. Judy Amabile (D-Colo.), who has witnessed limitations to Colorado鈥檚 mental healthcare system firsthand because her son has schizoaffective disorder.
In lieu of federal action, states are stepping up to bridge the gaps.
Colorado, 15 other states, and Washington, D.C., now operate under waivers allowing Medicaid to fund inpatient facilities with more than 16 beds for mental health treatment, according to KFF data. Seven additional states have waivers pending. One 2025 study found that these waivers may be tied to fewer hospitalizations, emergency department visits, and incarcerations among adults with serious mental illness.
Yet even local efforts to improve mental healthcare face resistance. In California, Colorado, Iowa, Missouri, Nebraska, and New York, locals have pushed back against proposed psychiatric facilities for minors, claiming such facilities will worsen safety and lower property values. Behavioral health advocates have disputed these claims and argued they are rooted in stigma.
That psychiatric facility in Colorado was ultimately greenlit. The state has nearly 20 inpatient beds per 100,000 people, ranking 24th nationwide, according to 2022 data across all 50 states plus Washington, D.C., collected by the Treatment Advocacy Center. Wyoming ranked first with 47.3 beds per 100,000 residents, although, as the least populous state, it has only 275 total inpatient beds compared with California鈥檚 5,703. Minnesota ranked last, with only 4.3 inpatient beds per 100,000 residents.
While increasing the number of inpatient psychiatric beds is vital, mental health advocates are also calling for more community-based supports, such as peer support specialists and clubhouses, where people with serious mental illnesses can learn life skills and find community.
When it came time for me to use our mental health safety net, I was among the fortunate ones: At noon the day after my hold began, a bed opened at a hospital in Denver — a rare stroke of luck in a system in which many people wait days or weeks for the care they need. An ambulance transferred me to the hospital at 3 p.m., marking 21 hours into my 72-hour hold.
Two days later, on my last day at the psychiatric hospital, I stood outside the nurse鈥檚 station awaiting discharge papers.
A man I had not seen before looked at me and asked, 鈥淎re you leaving?鈥�
鈥淵es,鈥� I said. 鈥淎re you being admitted?鈥�
鈥淵eah,鈥� he responded. 鈥淭his is my third time being hospitalized in a year.鈥�
I shook his hand. 鈥淕ood luck,鈥� I said, and I walked out the door.
Helen Santoro is a freelance writer for KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. Find her on Bluesky @helenwsantoro and LinkedIn: Helen Santoro.
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