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

Molecular Psychiatry volume 27, pages 1873–1879 (2022)Cite this article

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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.

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Fig. 1: Distribution of estimates for optimal, minimum, and shortage levels of psychiatric beds in the first and second round of a Delphi process.

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Acknowledgements

This study had funding by the Agencia Nacional de Investigación y Desarrollo, Chile, FONDECYT Regular 1190613. The funder financed research assistance to coordinate the research network and data collection. The funding agency had no influence in the design of this study or in the analysis and interpretation of the data, nor in the writing or the decision to submit this article for publication. The authors would also like to acknowledge the members of the expert panel for having shared their expertize and dedicated time to this study: Alma Dzubur Kulenovic, Amanda Cotton, Ana María Peñuela, Ángel Almánzar, Ashvini Nath, Avinash Desousa, Balogun Osunbiyi, Barbara Kane, Ben Beaglehole, Briggite Khoury, Dan Siskind, David Copolov, David Ndetei, Dennis Daliri, Dermont Hurley, Desree Karen Providence, Domenico Giacco, Dominic Sisti, Dusica Lecic-Tosevsky, Elena Molchanova, Elizabeth Sinclair Hancq, Eugenia Xatse, Farid Talih, Fuad Ismayilov, Giuseppe Guaiana, Harischandra Gambheera, Isabel Perera, Jeffrei Looi, Jimmy Lee, John Bohorquez, Juan Camilo Martínez, Juliet Mwale Musabala, Lena Flyckt, Luciano Grosso, Luis Taboada, Majda Cheour, Maris Taube, Maritza Troya, Martha Shumway, Maureen Maduagwu, Medhat Elsabbahy, Mohammad Akmar Paiman, Muzafami Mizuno, Nasser Loza, Nina Kerimi, Olga Karpenko, Peter Tyrer, Rani Hoff, Roger Ng, Roumen Milev, SM Yasir Arafat, Sammy Ohene, Sherry Chan, Shih Ku Lin, Sim Kang, Simon Judkins, Santosh Kumar Chaturvedi, Swapna Verma, Tarek Okasha, Tsirisoa Hary Seheno, Vesna Svab, Victoria Bird, Vinay Lakra, Walid Sarhan, and Yury Razvodovsky.

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Authors and Affiliations

  1. Facultad de Medicina, Universidad Diego Portales, Santiago, Chile

    Adrian P. Mundt & Enzo Rozas Serri

  2. Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile

    Adrian P. Mundt

  3. Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile

    Enzo Rozas Serri

  4. Ministry of Health, Republic of Chile, Santiago, Chile

    Matías Irarrázaval

  5. Millenium Institute for Research in Depression and Personality, Santiago, Chile

    Matías Irarrázaval

  6. Department of Psychiatry, Western University, London, ON, Canada

    Richard O’Reilly

  7. Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Stephen Allison

  8. Visiting Clinical Professor Department of Psychiatry Monash University Wellington Road, Clayton, 3800, Australia

    Tarun Bastiampillai

  9. Department of Psychiatry School of Medicine, Mulago Hospital, Makerere University College of Health Sciences, Kampala, Uganda

    Seggane Musisi

  10. Department of Psychology, Stellenbosch University, Stellenbosch, South Africa

    Ashraf Kagee

  11. Psychiatry and Medical Psychology, Chuvash State University, Cheboksary, Russian Federation

    Andrei Golenkov

  12. Department of Psychiatry, American University of Beirut, Beirut, Lebanon

    Joseph El-Khoury

  13. Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea

    Seon-Cheol Park

  14. Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea

    Seon-Cheol Park

  15. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA

    Lydia Chwastiak

  16. Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom

    Stefan Priebe

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  1. Adrian P. Mundt
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  13. Stefan Priebe
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Contributions

APM, ERS, MI, and SP conceived of the study; APM and ERS wrote the protocol and designed the survey; MI, SP, ROR, SA, TB, SM, AK, AG, JE-K, S-CP, and LC critically revised the survey and nominated Delphi panel members; APM and ERS conducted the data collection, data analyses, and drafted the manuscript; all authors critically revised the manuscript and approved the final version.

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Correspondence to Adrian P. Mundt.

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Mundt, A.P., Rozas Serri, E., Irarrázaval, M. et al. Minimum and optimal numbers of psychiatric beds: expert consensus using a Delphi process. Mol Psychiatry 27, 1873–1879 (2022). https://doi.org/10.1038/s41380-021-01435-0

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