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Losing Hospital Beds
Mental health beds crisis
A recent BBC report commissioned with Community Care magazine showed some frightening statistics about the beds crisis in mental health. 1700 NHS psychiatric in-patient beds have been lost in the last two years. Police and family carers are saying loudly they are picking up the pieces.
It got me thinking. For all the time I’ve been involved in mental health work people have said there’s not enough beds, we need more crisis beds, and community care services aren’t resourced enough. So people have been expressing concern about the loss of beds for a long time, and yet the slide to less and less beds continues. Is there a level to which we can’t fall any further without some really awful consequences?
History of bed closures
I looked up a bit of the history of psychiatric bed numbers in England and Wales. In 1954 there were close on 150,000 people in mental hospital beds. Since then the number of patients in psychiatric hospitals in England and Wales has declined dramatically – and it’s not just been about public finance pressures (though these are to the fore during the current debate). In many ways the idea of not keeping people in mental hospitals has been a progressive idea led by professionals, believing more effective care could be provided outside hospital. So by 1986 we were down to just under 100,000 beds, and by 1990 just under 60,000 beds. By 2006 there were 30,000 people in NHS psychiatric hospital beds.
Impact on health and care staff
Can it go down any further, and what’s to stop it, and what will be the impact on staff working in the field of mental health?
- There are some people in such an acute state of crisis that only intensive care and management in a hospital will keep them safe. Staff concerned with the care of people in crisis will go home at night worrying what might happen to someone if they haven’t been admitted into hospital.
- When someone desperately needs a bed, local NHS commissioners may to turn to private hospitals and their beds are expensive. If the savings to public finances by reducing NHS beds is outweighed by the cost of private beds, then commissioners will wonder how they can reverse the trend.
- Hospital staff will feel pressured to send patients home too early, before being established on treatment, if there is demand at the door of the ward for new patients to be admitted. Wards with 100% occupancy are almost impossible to manage.
- There will be a huge impact on mental health professionals. They are required to stick to the Principles of the Mental Health Act, the right for someone to be admitted informally, the right to the least restrictive alternative, having their family nearby, and being dealt with in a respectful and humane way – all stressfully difficult when a local bed is impossible to find. Statistics from the Health and Social Care Information Centre (www.hscic.gov.uk) show a 10% rise in the number of Community Treatment
Orders under the Mental Health Act between 2011-12 and 2012-13. Are we finding mental health professionals are replacing compulsory treatment in hospital with compulsory treatment in the community?
Effective discharge care planning
We don’t know how much further reductions in hospital bed numbers will go, but the pressures on other services means that effective discharge planning from hospital is vital. QCS policies and procedure on discharge from hospital can guide staff in helping smooth transition from hospital to care home .