In June 2018, San Diego's Tri-City Medical Center announced it would eliminate 30 inpatient psychiatric beds--including an 18-bed locked behavioral health unit and a 12-person crisis-stabilization unit. This closure is part of a 25-year reduction in California's supply of inpatient psychiatric beds, during a time when demand for mental health care services across the state has been increasing. In response to these developments, an investigation was conducted on the factors contributing to the availability of and demand for inpatient psychiatric care in the state. The findings are discussed in this report. The research looked in depth at three California counties--San Diego, Fresno, and Contra Costa Counties--which represent geographically diverse regions of the state and vary in terms of key demographic characteristics. For example, Contra Costa County has a relatively low share of residents covered by Medi-Cal and a low share of residents living in poverty compared with the state average. By comparison, Fresno County has a relatively high share of residents living in poverty and a high percentage of residents covered by Medi-Cal. San Diego County was selected in part because of the urgency generated by the closure of the Tri-County Medical Center's psychiatric units. Case studies of each of the three counties, set out in Appendix A, summarize qualitative information gathered through interviews with key stakeholders and quantitative information based on publicly available data.
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