Most health systems have been closing behavioral medicine beds for years. The patients that fill beds in the facilities that still exist are usually on Medicaid or unfunded. It’s tough to breakeven on that type of payer mix. As noted, states have closed the state owned facilities, but the void created wasn’t filled by privately owned systems because of the poor economics. In some states, the number of providers willing to work on the in-patient side of behavioral medicine is also an issue. Most providers want to have a commercial insurance out-patient practice. The issue is especially acute in states that didn’t expand Medicaid, further degrading the payer mix. Outside academic medicine (and academics is a small percentage of healthcare infrastructure overall), our approach to behavioal medicine is failing. I will offer the disclaimer that my experience is in the rust belt and Deep South, so it might be skewed.
The current economics in healthcare may cause another wave of bed closures, as systems are really taking a beating. I am interested where folks think the funds could come from without raising taxes to improve the safety net.