Capacity Constraints in Pediatric Inpatient Psychiatric Care: A Cross-Sectional Analysis of Bed Availability and Geographic Access in North Carolina

Authors: Ashley Parks , Keysha Workman and Matthew Lazari

DOI: 10.23880/jqhe-16000441

Volume 9, Issue 2

Abstract

Background: Access to mental health services for children and adolescents has emerged as a critical public health concern. Despite rising rates of depression, anxiety, and suicidality among youth, inpatient psychiatric capacity has not kept pace with demand, particularly for pediatric populations. Limited bed availability, geographic concentration, and inconsistent public reporting create significant barriers to care.

Objective: The purpose of this study was to characterize pediatric inpatient psychiatric bed capacity in North Carolina using publicly available regulatory and health system data, evaluate geographic distribution of services, and assess the extent of data gaps across facility types.

Study Design: Cross-sectional, descriptive analysis using publicly accessible administrative, regulatory, and health system data.

Methods: A tiered data source framework was developed to guide facility identification and data abstraction. Facilities were identified through the North Carolina Division of Health Service Regulation (DHSR) Mental Health Hospital licensing roster and supplemented with Certificate of Need (CON) documents, official health system sources, and secondary public sources. Pediatric inpatient psychiatric bed counts were recorded only when explicitly reported; no estimation or extrapolation was performed.

Results: Sixteen facilities and health system entities were identified. Seven freestanding psychiatric hospitals provided verifiable pediatric bed counts totaling 334 beds. Including two hospital-based units with verified capacity, total documented statewide pediatric inpatient psychiatric capacity reached approximately 372 beds, corresponding to 13.9–15.5 beds per 100,000 youth. Capacity was geographically concentrated in a small number of counties, with 92 of 100 North Carolina counties lacking any documented pediatric inpatient psychiatric resources.

Conclusion: Pediatric inpatient psychiatric capacity in North Carolina is limited, geographically concentrated, and incompletely characterized due to inconsistent reporting. Improved data transparency and standardized reporting are needed to support effective health system planning and ensure equitable access.

Keywords: Psychiatry; Inpatient Capacity; Mental Health; North Carolina; Geographic Access; Health Systems Planning

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