Acute inpatient psychiatry in England: an old problem and a new priority

Abstract

Abstract. With the development of community care, the number of National Health Service psychiatric beds in England has been reduced to between one-fifth and one-quarter of those provided in the mid-1950s. Psychiatric bed numbers are close to the irreducible minimum if they have not already reached it. The problems facing today's acute psychiatric admission wards include: poor design, maintenance and ambience; a lack of therapeutic and leisure activities for patients leading to inactivity and boredom; frequent incidents of aggression and low-level violence and problems with staffing. It is suggested that there are a number of underlying causes: First, there has been failure to plan inpatient services, or to define their role, as attention has focused on new developments in community care. Second, the reduction in bed numbers has led to a change in the casemix of inpatients with a concentration on admission wards of a more challenging group of patients. Third, admission ward environments are permeable to the adverse effects of local street life, including drug taking. After years of neglect, acute inpatient psychiatric services in England are now high on the UK Government agenda. The paper lists a number of national initiatives designed to improve their quality and safety. A recent review of qualitative research suggests that acute psychiatric wards in other countries face similar problems to those reported in England. It is suggested that there might be a need for joint action which might take the form either of international research about acute inpatient care or the development of international standards and a common quality improvement system.

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

“…5 Concerns about a perceived shortage of acute inpatient places in England and Wales are also not a recent phenomenon, 75 with some arguing that 'psychiatric bed numbers (in England) are close to the irreducible minimum if they have not already reached it'. 76 More recently, the coalition government's care services minister admitted that 'there is clearly, in some parts of the country, a shortage of beds'. 77 The (then) minister's reference to 'some parts of the country' hints at the variation in the provision of inpatient beds reported by the NHS Benchmarking Network mapping exercise in 2014.…”

Crisis teams: systematic review of their effectiveness in practice

“…18 Contemplating CRTs further reducing admissions must be contextualised by consideration that current bed numbers may be close to a practical minimum. 19 An interesting finding was work showing a relationship between CRT introduction and increased length of admission. 12 The interpretation of this is open to debate, but a posited explanation is that CRT gatekeeping means those actually admitted were typically more ill; alternatively, it is conceivable that fewer admissions resulted in less ward pressure to discharge.…”

Psychiatric Units in general hospitals. Problems and perspectives in Europe

“…In order to foster a discussion on these topics, comparing different situations and international experiences, such as those described in England (Lelliott, 2006) in Ireland (Walsh, 2006) and in Scandinavian countries (Ruud et al, 2006), we have devoted the editorials of this journal's issue to acute inpatient care, with the hope that these contributions will stimulate discussion and help improve acute inpatient care.…”

“…E proprio per avviare una riflessione su questi temi, comparando situazioni ed esperienze intemazionali di tipo diverso, ma pur sempre caratterizzate da una analoga problematicita come quelle inglesi (Lelliott, 2006), irlandesi (Walsh, 2006) e scandinave (Ruud et al,, 2006) che dedichiamo gli editoriali di questo numero di EPS al tema dei reparti psichiatrici per acuti, nella speranza che anche questi contributi stimolino il dibattito in corso e suscitino riflessioni rigorose ed appassionate, che costituiscono il punto di partenza irrinunciabile per migliorare l'esistente.…”