Colorado has for years been short on in-patient psychiatric beds for people with severe mental illness, creating a backlog that means people wait months for care and sit in jail instead of a hospital.
The last time the national Treatment Advocacy Center released a status report on the psychiatric bed shortage, Colorado placed 34th among states with 543 beds.
It’s only gotten worse in the past seven years, according to the center’s latest analysis, released Wednesday and based on 2023 data.
The number of psychiatric beds at Colorado’s state mental hospitals, in Pueblo and Denver, dropped by 20% — to 482 last year.
And Colorado is third-worst in the nation for the number of people per capita who are waiting for forensic psychiatric beds, which are used to treat people who are found incompetent to face criminal charges or not guilty by reason of insanity.
Colorado had 448 people on the waitlist, waiting an average of 66 days, according to the analysis.
It’s not that the number of beds in Colorado actually shrunk; it’s that the state has been so short on staff, nurses in particular, that it shut down sections of the Colorado Mental Health Hospital campuses in Pueblo and Fort Logan in southwest Denver. The campuses, which treat people in the criminal justice system and people who have been civilly committed, eliminated a combined 100 beds during the early days of the coronavirus pandemic and have not reopened them all.
The shortage is not quite as bad in Colorado today as it was last year, when the national analysis was completed, according to the Colorado Department of Human Services.
The state’s two mental hospitals, needing to fill 263 nursing positions, started offering $14,000 signing bonuses in June. They were able to fill 42 nursing positions within six months last year, thanks to the bonuses, a 5% raise for state employees and an additional 8% temporary raise for nurses.
All of the 138 psychiatric beds at Fort Logan are now open. The Pueblo hospital, meanwhile, is operating 463 beds — up from 422 last year, but still below its capacity of 516.
The bed shortage is not just a Colorado problem. There were 19 states that lost at least 20% of their state-run psychiatric beds from 2016 to 2023.
Nationwide, the number of state beds for people with severe mental illness dropped to its lowest point ever, at 10.8 beds per 100,000 people. The optimal number, according to mental health system experts, is estimated at 40-60 beds per 100,000 people.
Just more than half of the beds, 52%, are filled with people who were sent for treatment by the criminal justice system. That’s a 56% increase since 2010, which means there are fewer beds available for those who have not committed crimes but need mental health treatment.
“The reality that an immeasurable number of people with treatable diseases only get treatment when they get sick enough to commit crimes that send them to jail and then to a forensic bed should be a source of national shame and outcry for reform,” said the report from the Virginia-based Treatment Advocacy Center.
The number of state-run psychiatric beds has been dropping across the country since the 1950s, when there were 339 beds per 100,000 people. In 1950, there were 512,501 people in state mental hospitals. Today, there are 36,150.
Many mental hospitals closed over the decades because of efforts to treat people in the community instead of institutions, and because private companies opened in-patient psychiatric treatment centers.
But private hospitals typically do not take patients who have been ordered into treatment through the criminal justice system. And private hospitals often do not take people with the most severe behavioral problems or those who cannot pay, which means state hospitals are sometimes the only option.
Mental Health Colorado president Vincent Atchity called on Colorado to “disentangle” mental health care from the criminal justice system.
“The number of people being held in Colorado jails when they should be getting health care is an unacceptable tragedy,” he said. “Not only are their rights being violated, but over-incarceration and this competency backlog create a devastating domino effect of unmet health needs as many Coloradans cycle through jails, homelessness, crisis centers, and ERs without ever getting the care they need to stabilize.”
Colorado is now contracting with private hospitals for 61 beds for people sent to treatment through the criminal justice system. The state is renovating a wing at Fort Logan to add 16 beds in 2025. And, it is working toward opening 164 beds statewide for people who have been stabilized in mental health hospitals but are not ready to live at home.
Colorado has a long, expensive backlog of people whose criminal trials are delayed due to the forensic bed shortage. The state is paying about $12 million each year in fines as part of a federal consent decree that came after multiple rounds of lawsuits against the state, including from Disability Law Colorado, which first sued over the issue more than a decade ago.
Colorado was required under the terms of the 2012 lawsuit to provide a mental health evaluation or treatment within 28 days of arrest, a timeline the state has struggled to meet. The fines go into a designated fund intended to solve the backlog.
The vacancy rate for nursing positions at Fort Logan is now at 21%, an improvement from 60% in 2022. The Pueblo campus has only improved a little — to 48% vacancy from 52%.