In Sweden, more resources have been allocated to expanding outpatient psychiatric care while the number of inpatient beds is steadily declining. A study by Lund University shows a statistical link between fewer psychiatric beds and higher suicide rates. The study was published in The Lancet Regional Health -Europe.
Demand for psychiatric care is rising, and in 2024 the National Board of Health and Welfare reported over 5.5 million contacts in specialist outpatient psychiatric care. At the same time, many high-income countries, including Sweden, have been reducing the number of inpatient psychiatric beds for a long time. Intensive efforts are currently underway, both nationally and internationally, to strengthen suicide prevention, but within this work, access to inpatient care has so far received relatively little attention. Inpatient care is an emergency measure taken in a crisis situation, with the aim of providing the patient with a safe environment around the clock, access to healthcare staff, and the treatment they need at the right time.
Fewer hospital beds and changes to psychiatric care
"Since I started working in psychiatry, over 15 years ago, I have seen how inpatient care has changed and how the number of beds has fallen over time. Meanwhile, the thresholds for admitting patients have been raised and ward turnover is increasing," says Jonas Berge, docent and researcher in psychiatry at Lund University and senior consultant in psychiatry at the Addiction Centre in Malmö, Region Skåne.
A sharp decline since the 1970s
Since the 1970s, the number of inpatient beds in Sweden has fallen by 80-90 per cent. Between 2015 and 2024, the number of beds in adult psychiatric care - excluding forensic psychiatry - fell from 31 to 24 per 100,000 inhabitants. The researchers therefore wanted to investigate whether the number of suicides had been affected by this trend and collected data from 20 of Sweden's 21 regions during this period. Data on suicides was obtained from the National Board of Health and Welfare's Cause of Death Register, and information on the number of psychiatric beds and healthcare budgets was obtained from the Swedish Association of Local Authorities and Regions.
"The results show a statistical correlation between fewer psychiatric beds and higher suicide rates. If we were to extrapolate this trend to Sweden's population - approximately 10.6 million people in 2024 - a return to the 2015 level of hospital beds could result in 83 fewer suicides per year."
The total number of suicides has remained virtually unchanged over the same period, despite for example, more evidence-based methods in psychiatry and the expansion of outpatient care. The researchers behind the study suggest that one possible explanation is precisely that the number of hospital beds has fallen, which points to significant potential for further improving suicide prevention.
"One argument in favour of reducing the number of inpatient beds is precisely the emphasis on more accessible outpatient care; however, in our study we found no correlation between a higher budget for outpatient care in different regions and a reduction in suicides."
Key implications for future planning
The fact that reductions in the number of inpatient beds may have an impact on suicide rates is something that must be taken into account in future healthcare policy, both in Sweden and in other high-income countries. The question of how healthcare resources should be allocated between inpatient and outpatient care, and how the healthcare system can best be designed to prevent suicide, is therefore more relevant than it has been for a long time, according to Jonas Berge.
"In future studies, we need to take a closer look at which patients benefit most from inpatient care and when access to hospital beds really makes the biggest difference."
