What happens when 55% of acute psychiatric beds are closed in six days: an unexpected naturalistic observational study

Abstract

ObjectiveThe sudden closure of 30 out of 54 acute psychiatric beds in Cornwall presented a stressful challenge to staff but also a natural experiment on how a service dealt with this situation. We aimed to evaluate the outcomes of patients needing to leave the closed ward, how bed occupancy rates were affected and the impact on admission rates.DesignA service evaluation of the impact of the ward closure.SettingA comprehensive secondary NHS mental health service in Cornwall serving 550,000 population.Main outcome measuresThe destination of the patients needing to leave the acute unit, the effect of the closure on bed occupancy, admission rates and serious untoward incidents.ResultsOf 26 patients needing to be moved from the acute ward, only 10 needed an acute psychiatric bed. None of the seven patients who had been on the ward longer than nine weeks needed an acute unit. Admission rates fell over the subsequent three months. There was no increase in serious incidents due to the closure.ConclusionsThis naturalistic event suggests that many patients on acute units could be cared for elsewhere, especially recovery/rehabilitation care environments, if political and financial urgency is present. Admission rates are responsive to the pressure on beds.

Expert Arguments for Trends of Psychiatric Bed Numbers: A Systematic Review of Qualitative Data

“…Reducing long-stay patients allows for further bed removals, especially considering that inpatient bed capacity and availability generates utilization and coercive treatments. However, there are economic incentives for inadequately long inpatient bed use (39,40,48,57,64,71,78,79,81,83,116).…”

“…The transfer of patients from acute to community care allows for treatment in a more adequate setting, which could improve aggressive behavior and reduces stress of patients and careers generated by acute admissions far from home (48,120).…”

“…In regard to arguments supporting the further reduction of psychiatric beds, most authors referred to long-stay beds and to inappropriately long lengths of stay (71,78,79,81,83), emphasizing that patients could be transferred to the community if more timely and adequate after-care could be found (33,39,40,48,64). The paradigm emerged that successful development of effective community services, including housing, and a better integrated mental health system would allow to continue psychiatric bed removals without negative outcomes (4-6), especially considering that inpatient services can be restrictive environments (48). We observed that a further reduction of psychiatric beds was usually not recommended for LMICs, except for Moldova (88).…”

The Early Impact of the COVID-19 Pandemic on Acute Care Mental Health Services

“…Our investigation confirmed our core hypotheses: CRHT referrals and inpatient admissions were lower during the COVID-19 period than during the same period in the two previous years. Earlier research has shown that inpatient admission rates in the NHS can be decreased in the short term to adapt to pressures-especially urgent pressures (5). We speculate that, with the COVID-19 outbreak at the forefront of individuals' concerns, psychiatric patients were more reluctant to seek treatment, following a pattern of behavior seen in other medical fields (6).…”