Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-27T17:22:34.533Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  18 May 2011

Paul Lelliott
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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.

Type
Editorials
Information
Epidemiology and Psychiatric Sciences , Volume 15 , Issue 2 , June 2006 , pp. 91 - 94
Copyright
Copyright © Cambridge University Press 2006

References

REFERENCES

Caird, H., Worrall, A. & Lelliott, P. (2004). The Electroconvulsive Therapy Accreditation Service (ECTAS). Psychiatrie Bulletin 28, 257–259.CrossRefGoogle Scholar
Department of Health (1999). National Service Framework for Mental Health: Modem Standards and Service Models Department of Health: London. Retrieved February 23, 2006, from http://www.dh.gov.uk/assetRoot/04/07/72/09/04077209.pdfGoogle Scholar
Department of Health (2002). Mental Health Policy Implementation Guide: Adult Acute inpatient Care Provision. Department of Health: London. Retrieved February 23, 2006, from http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4009156&chk=hdBfGn.Google Scholar
Fitzpatrick, N.K., Thomson, C.J., Hemingway, T.R.E., Barnes, A., Higgitt, A., Molloy, C. & Hargreaves, S. (2003). Acute mental health admissions in inner London: changes in patient characteristics and clinical admission thresholds between 1988 and 1998. Psychiatric Bulletin 27, 7–11.CrossRefGoogle Scholar
Goffman, E. (1961). Asylums. Penguin: London.Google Scholar
Healthcare Commission (2005). National Audit of Violence (2003–2005). Healthcare Commission: London. Retrieved February 23, 2006, from http://www.healthcarecommission.org.uk/assetRoot/04/01/74/51/04017451.pdfGoogle Scholar
HMSO (2000). The NHS Plan: a Plan for Investment a Plan for Reform. HMSO: London. Retrieved February 23, 2006, from http://www.dh.gov.uk/assetRoot/04/05/57/83/04055783.pdfGoogle Scholar
King's Fund (2003). London's State of Mind: King's Fund Mental Health Inquiry 2003. King's Fund: London.Google Scholar
Lamb, H.R. & Bachrach, L.L. (2001). Some perspectives on deinstitutionalization. Psychiatric Services 52, 1039–1045.CrossRefGoogle ScholarPubMed
Lelliott, P. (1996). Meeting the accommodation needs of the most severely mentally ill people. Journal of Interprofessional Care 10, 241–247.CrossRefGoogle Scholar
Lelliott, P. & Quirk, A. (2004). What is life like on acute psychiatric wards? Current Opinion in Psychiatry 17, 297–301.CrossRefGoogle Scholar
Lelliott, P. & Wing, J.K. (1994). National audit of new long-stay psychiatric patients. II. Impact on services. British Journal of Psychiatry 165, 170–178.CrossRefGoogle Scholar
Marshall, H., Lelliott, P. & Hill, K. (2004). National Patient Safety Agency Safer Wards for Acute Psychiatry: a Review of the Available Evidence. National Patient Safety Agency: London. Retrieved February 23, 2006, from http://www.npsa.nhs.uk/site/media/docu-ments/1241_SWAP_ResearchReport.pdfGoogle Scholar
Mental Health Act Commission (2005). In Place of Fear: 11'th Biennial Report 2003–2005. The Stationery Office: London. Retrieved February 23, 2006, from http://www.mhac.org.uk/Pages/docu-ments/publications/MHAC%2011%20TEXT%20FA.pdfGoogle Scholar
MILMIS Project Group (1995). Monitoring inner London mental illness services. Psychiatric Bulletin 23, 257–259.Google Scholar
Muijen, M. (1999). Acute hospital care: inefficient, ineffective and poorly organized. Editorial. Psychiatric Bulletin 23, 257–259.CrossRefGoogle Scholar
NICE (2005). Violence - The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments. National Institute for Health and Clinical Excellence: London. Retrieved February 23, 2006, from http://www.nice.org.uk/page.aspx?o=244477.Google Scholar
Phillips, P. & Johnson, S. (2003). Drug and alcohol misuse among in-patients with psychotic illnesses in three inner-London psychiatric units. Psychiatric Bulletin 27, 217–220.CrossRefGoogle Scholar
Quirk, A., Lelliott, P. & Seale, C. (in press). The permeable institution: an ethnographic study of three acute psychiatric wards in London. Social Science and Medicine.Google Scholar
Rose, D. (2000). Users' Voices. The Sainsbury Centre for Mental Health: London.Google Scholar
Rethink, (2004). Behind Closed Doors: Acute Mental Health Care in the UK. Rethink: London. Retrieved February 23, 2006, from http://www.rethink.org/research/pdfs/Behind-Closed-Doors-Report.pdf.Google Scholar
Royal College of Psychiatrists Research and Training Unit (2006). Acute Psychiatric Ward Accreditation Service: Service Standards. Retrieved February 23, 2006, from http://www.rcpsych.ac.uk/cru/qual.htm.Google Scholar
Sainsbury Centre for Mental Health (2005). Acute Care 2004: a National Survey of Adult Psychiatric Wards in England. Sainsbury Centre for Mental Health: London.Google Scholar