Characteristics of Inpatient Psychiatric Units in Small Rural Hospitals

Document Type


Publication Date



Rural, hospitals, pychiatric units, survey, MRHRC, USM Aging Initiative, Health and Wellness

Publication Title

Psychiatric Services


Objectives: This study investigates inpatient psychiatric units (IPUs) in small rural hospitals todetermine their characteristics, the availability of community-based services post discharge, and the impact of the new Medicare payment system on these units. Methods: Telephone survey of IPU managers in all rural hospitals with less than 50 beds that had an IPU in 2006 (n=86). Seventy-three interviews completed for a response rate of 85%. Results: A typical small rural hospital IPU is a 10-bed geriatric unit with 200 admissions per year. They are paid primarily by Medicare (median of 84%), and are typically staffed with one each of psychiatrists, psychologists, social workers, counselor/therapists or nurse practitioners. Total staffing including nursing and unlicensed staff averages 18 FTEs. Common diagnoses were depression (74%), schizophrenia or other psychoses (57%) and dementia or Alzheimer’s (57%). IPU managers reported little difficulty obtaining post-discharge care (average 5% of patients). Most clinicians staffing IPUs also provide out-patient services locally (86% of psychiatrists and 81% of psychologists). Of 8 recently closed IPUs, 5 reported closing due, in part, to changes in Medicare reimbursement. Conclusions: Rural IPUs have good access to community-based services. We conclude that these communities have a better infrastructure of mental health services, due, in part, to the presence of the IPU, and the willingness of IPU clinicians to provide out-patient services locally. We also conclude that changes in Medicare reimbursement have contributed to closure of some of these units, and may, thereby, contribute to the erosion of the rural mental health infrastructure.