JR., 2016 УДК 616-058 (100) John C. Reid Jr. EMERGENCY ROAD TRIPS: AN ANALYSIS OF SPATIAL BARRIERS TO INPATIENT STATE PSYCHIATRIC CARE FOR SELECT U.S. STATES1 MA, 2016 MPH Candidate Columbia University Joseph H. Mailman School of Public Health Background From its peak in the 1950s, the number of state psychiatric inpatient beds in the United States has decreased steadily. <...> Today, not one U.S. state meets the generally accepted minimum of 50 inpatient beds per 100,000 in the population. <...> The last time the inpatient psychiatric bed situation was so dire was 1850 [1], when the plight of the seriously mentally ill fi rst attracted attention in the U.S. Deinstitutionalization is the result of societal shifts and policy changes over the last half century, and while the effect in the U.S. has been particularly stark, the broader trend is on display in many high income European countries [2]. <...> By the 1970s, psychiatric hospitals had gained a reputation for substandard care, the likes of which was the subject of the 1975 Jack Nicholson fi lm One Flew Over the Cuckoo’s Nest, which was fi lmed at Oregon State Hospital in Salem, Oregon. <...> That hospital opened in the mid-1880s and is still in operation despite numerous citations for unsafe conditions and asbestos exposure [3]. <...> Indeed, despite 50 years-worth of closures, many states still operate psychiatric hospital facilities that were constructed more than 100 years ago, and many that were built in the 19th century. <...> This state of affairs is the result of the political diffi culties that come with trying to allocate money for new facilities — the public still associates psychiatric hospitals with negative stereotypes from the 20th century. <...> However, small steps are possible, and state policymakers need the best available evidence in order to decide where future facilities should be constructed. <...> Drawing on my past research in this area, this paper analyzes the role geographic distance plays in serving as a barrier to acute mental health care in states with poor mental health outcomes and low inpatient turnover ratios, which taken together suggest unmet need <...>