Colorado has faced a shortage of forensic psychiatric beds in its state hospitals for individuals with severe mental illness for nearly a decade, with the height of the shortage occurring in 2023. Forensic psychiatric beds are allocated to people deemed incompetent to stand trial or found not guilty by reason of insanity.
The years-long shortage has resulted in longer wait times and extended jail stays for those awaiting evaluation or treatment. A Treatment Advocacy Center report published in January 2024 named Colorado as having the third-longest waitlist in the U.S. Throughout 2023, 448 individuals were placed on the waitlist, facing an average delay of 66 days before receiving necessary treatment.
The number of psychiatric beds in Colorado’s state mental health facilities gradually decreased between 2016 and 2023. From 2022 to 2023, the facilities in Denver and Pueblo experienced a 20 percent reduction, bringing the total number of available beds in those hospitals down to 482.
The decline was not a result of fewer physical beds, but rather a shortage of nursing staff. The Colorado Mental Health Hospital campuses in Pueblo and Fort Logan closed a combined total of 100 beds during the early stages of COVID-19, and some of these beds have not yet reopened.
This is a national trend. From 2016 to 2023, 19 states experienced a 20-percent drop in state-run psychiatric beds. Nationwide, the number of beds for individuals with severe mental illnesses hit a record low in 2023, with only 10.8 beds per 100,000 people. For adequate care, experts recommend 40 to 60 beds per 100,000 people.
Cory Reid-Vanas, a licensed therapist and owner of Rocky Mountain Counseling Collective in Denver, warns that the lack of beds can potentially worsen the mental state of people waiting in custody. “Crisis response as primary care means people only receive help at their worst moments, missing opportunities for prevention and creating cycles of crisis,” Reid-Vanas said. “Emergency interventions are often more traumatic and less effective than consistent preventative care.”
The current system, according to Reid-Vanas, criminalizes mental illness by making jails and prisons de facto mental health facilities, forcing law enforcement to act as first responders to mental health crises, and creating records that can impact employment and housing. “When people can't access preventative care, public crises become more common, reinforcing stereotypes about mental illness being dangerous and unpredictable,” he said.
To address these problems, Colorado's Joint Budget Committee allocated $68 million in January 2024 to help reduce the state's waitlist for psychiatric beds. Three forensic health units and several beds that were previously closed due to staffing shortages will be opened using the funds.
However, the need for psychiatric beds still exceeds availability, highlighting the ongoing need for long-term investment in mental health infrastructure and workforce development to provide timely and sufficient care.
According to Reid-Vanas, key resources that need investment include community mental health centers, training programs for mental health professionals (especially in rural areas), developing telehealth infrastructure, and improving insurance coverage for preventative care. “In Colorado specifically, rural areas face severe provider shortages, insurance coverage is often limited, and waitlists for providers can be months long,” he said.