Real-Time Bed Availability: The Next Frontier for Behavioral Health and Crisis Interoperability

When someone is in the middle of a behavioral health, substance use, or crisis event, “waiting for a bed” can mean waiting for help. Whether that person is sitting in an emergency department, holding in a county jail, or waiting on a mobile crisis team, the delay between identifying the need and finding a placement can be the most dangerous part of their care journey. Yet, even as health systems invest in data infrastructure, real-time visibility into available beds remains one of the biggest blind spots in behavioral health and social care systems.

The Visibility Problem

For behavioral health, SUD, and crisis populations, placement is rarely straightforward. The right bed depends on clinical need, insurance coverage, geography, and program eligibility. Many facilities still rely on phone calls, spreadsheets, or even faxed updates to share their capacity, making the process as cumbersome as it is outdated. While acute medical care has embraced electronic exchange, behavioral health and social care data often remain siloed and invisible to the broader care ecosystem.

The absence of real-time bed visibility creates ripple effects across the continuum. Patients board for hours or days in emergency departments. Crisis teams spend more time calling than coordinating. Law enforcement becomes an unintended part of the care chain. And communities lose valuable capacity to inefficiency.

What Bed Availability Software Actually Solves

Bed availability software does more than list open slots. It provides the infrastructure to match patient needs with real-time capacity across inpatient, residential, and step-down levels of care. By layering eligibility criteria, referral management, and closed-loop feedback, these platforms shorten the time between crisis and care.

A strong example comes from Bamboo Health’s OpenBeds® platform, deployed in multiple states to modernize behavioral health referrals. In Delaware, for instance, the system improved psychiatric hospital referral response times by 98% and increased follow-up appointment adherence to over 80%. More importantly, it allowed crisis lines, hospitals, and community providers to work from the same shared data—reducing bottlenecks and freeing emergency departments for higher-acuity patients. Behavioral Health Link (BHL) has also advanced this model through its Real-Time Bed Registry in Georgia. In its 2023 Trends Report: Top Five Movements in Behavioral Crisis Care Software, BHL named real-time bed registries one of the most transformative tools in crisis care, emphasizing their integration across mobile crisis, call centers, and referral workflows. Its 2024 article, Navigating Crisis with Precision: How BHL’s Data Lights the Way, describes how Georgia’s platform now tracks capacity, utilization, and outcomes in near real time—creating feedback loops that help state agencies identify service gaps and allocate resources more efficiently. These models illustrate a broader point: technology alone doesn’t solve access problems, but trusted, well-governed data does. When referral systems, crisis lines, and providers share a real-time view of capacity, patients move faster to the right level of care.

Lessons from Virginia: Transparency with Infrastructure

In Virginia, the Virginia Hospital & Healthcare Association (VHHA) has taken a data-driven approach with its Behavioral Health Inpatient Data Dashboard—a public-facing tool that reports psychiatric admissions and occupancy trends across the state.

Launched in partnership with the Virginia Department of Behavioral Health and Developmental Services, the dashboard integrates data from both state-run and private hospitals. According to VHHA’s 2022 press release, private hospitals account for about 90% of all behavioral health inpatient admissions statewide—roughly 60% voluntary and 30% via temporary detention orders (TDOs). Users can filter by admission type, year, and facility to visualize patterns in access, utilization, and population needs.

While the dashboard isn’t yet a live bed registry, it represents an important foundation: transparent, standardized data that policymakers and providers can use to target investments, identify bottlenecks, and monitor progress. VHHA leaders note that “data-driven decision-making is informed decision-making,” underscoring the trust-building role of analytics as a precursor to interoperability. For HIEs, this model demonstrates how open data frameworks can evolve into fully integrated, real-time systems.

One way an HIE could be leveraged is through CRISP Shared Services (CSS), which supports Virginia’s statewide health information exchange. CSS already manages encounter notifications, care coordination, and data-sharing across hospitals and behavioral health providers, offering the governance and technical backbone needed for real-time coordination. By integrating Virginia’s statutory bed-registry data into the HIE’s infrastructure, the state could move from static occupancy dashboards to live capacity management and referral workflows. In this model, the HIE becomes the connective tissue linking crisis lines, emergency departments, and inpatient facilities—turning visibility into action

Transformation in Massachusetts: From Boarding to Visibility

Massachusetts offers one of the clearest examples of how visibility can lead to measurable change. For years, emergency department boarding for behavioral health patients was among the worst in the nation—especially for children. In early 2024, the Massachusetts Health Policy Commission (HPC) reported that nearly half (47%) of children admitted to an inpatient psychiatric bed spent more than 24 hours boarding in an ED. For behavioral health–related visits overall, the boarding rate increased from 31% in 2020 to nearly 39% by 2024.

That same year, the Massachusetts Hospital Association (MHA) began publishing a Behavioral Health Boarding Report that tracks, in near real time, how many patients are waiting for psychiatric placement, by region, age, and facility type. The state’s Behavioral Health Roadmap (updated May 2024) reported that boarding rates for the first four months of 2024 dropped 25% compared to 2023 and 62% compared to early 2022, indicating tangible progress as bed-matching and referral tools improved.

Perhaps most importantly, Massachusetts codified this work through policy. The 2022 Mental Health ABCs Act mandated creation of an emergency department boarding portal and a real-time bed search tool for pediatric psychiatric beds—a legislative recognition that the problem isn’t just supply, but visibility and coordination. Together, these efforts are transforming what “bed tracking” means—from static counts to actionable data that helps get patients out of holding patterns and into treatment.

The Role for HIEs

Health Information Exchanges (HIEs) are uniquely equipped to extend these efforts. They already connect the technical and policy dots between hospitals, behavioral health providers, and state agencies. By integrating bed-availability modules into existing HIE platforms, they can transform passive data exchange into active coordination. Rather than reinventing the wheel, HIEs can:

• Automate facility updates through existing ADT and encounter feeds.

• Embed capacity dashboards into crisis and referral workflows.

• Use aggregated data to identify regional disparities and inform funding.

• Serve as neutral data stewards, building trust among competitive providers.

This is the kind of infrastructure that moves systems from reporting to response—from “how many” to “who, where, and when.”

Building the Connected Crisis System

The push to strengthen 988 crisis systems and integrate behavioral health with social care makes real-time bed visibility a cornerstone of modern interoperability. Imagine if crisis lines, emergency departments, and peer navigators all accessed a shared dashboard showing open crisis stabilization units, residential treatment programs, and transitional housing in real time. The result isn’t just faster placement—it’s equity, continuity, and dignity for people in crisis.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has long recognized that a fully functional crisis system requires three pillars: someone to call, someone to respond, and somewhere to go. Its National Guidelines for Behavioral Health Crisis Care emphasize that stabilization services and bed capacity are essential infrastructure for that third pillar—“a safe place for help.” The 2025 update to SAMHSA’s National Guidelines for a Behavioral Health Coordinated System of Crisis Care explicitly calls for states to establish data systems that support capacity management, referral coordination, and visibility into available crisis stabilization and inpatient resources. Integrating these data flows into HIE platforms provides a direct mechanism to operationalize that guidance, ensuring that 988 response, mobile crisis teams, and treatment facilities work from the same real-time picture of capacity—turning policy vision into practical interoperability.

The states already leading this work—Georgia, Virginia, Massachusetts and Delaware, illustrate different steps on the same journey. Each has recognized that capacity visibility is not just an operational upgrade; it’s a patient safety imperative. For HIEs, this represents the next frontier of the last mile: where data stops sitting in systems and starts moving people toward care.