Inpatient Mental Health Services Are Being Neglected

November 06, 1998

(One day survey by the Mental Health Act Commission of acute adult psychiatric inpatient wards in England and Wales)

Over the past 50 years the number of psychiatric patient beds in England has decreased greatly. The number has fallen from 150,000 in 1955 to 42,000 in 1994-95. Despite the increase in community services, these beds still account for two-thirds of expenditure on mental health services.

In this week's BMJ, Dr Richard Ford and colleagues from the Sainsbury Centre for Mental Health in London report on the state on adult psychiatric inpatient units in England and Wales. Their study is based on an unannounced one day visit by the Mental Health Act Commission to acute psychiatric wards on 21 November 1996. They found that there is a relative neglect of inpatient services, as opposed to the focus that has been placed on activities in the community.

Their visit revealed that leave arrangements for patients on psychiatric wards (who were given 'trial' periods in the community) caused considerable difficulties in bed management, not helped by their finding that around one-third of nursing staff seem to be employed on a casual basis. Ford et al found that nurses spent much of their time engaged in intensive observation of a few patients, but a quarter of wards had no nurse interacting with patients at the time of the national visit. Only one-third of the female patients had the use of self contained, women-only areas.

They conclude that London wards have the most severe problems and that policy making, management and training must be refocused to improve the quality of acute inpatient psychiatric care.


Dr Richard Ford, Head of Service Evaluation, Sainsbury Centre for Mental Health, London <--end pdf link-->


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