Relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units, and alternative residential options: a cross sectional survey, one day census data, and staff interviews
Objectives: To examine the relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units and to explore the range of alternative residential options. Design: Cross sectional survey, combined with one day census data; ratings by and interviews with staff; examination of routine data sources. Settings: Nationally representative sample of acute psychiatric units. Subjects: 2236 patients who were inpatients on census day. Main outcome measures: Bed occupancy levels, judged need for continuing inpatient care, reasons preventing discharge, scores on the Health of the Nation outcome scales. Results: Bed occupancy was related to social deprivation and total availability of acute beds (r =0.66, 95% confidence interval 0.19 to 0.88, F=8.72, df=2, 23; P=0.002). However, 27% (603/2215) of current inpatients (61% (90/148) of those with stays of >6 months) were judged not to need continuing admission. The major reasons preventing discharge were lack of suitable accommodation (37% (176/482) of patients in hospital 6 months); inadequate domiciliary based community support (23% (113) v 9% (8)); and lack of long term rehabilitation places (21% (100) v 47% (40)). Scores on the Health of the Nation outcome scale were generally consistent with these staff judgments. Conclusions: The shortage of beds in acute psychiatric units is related to both social deprivation and the overall availability of acute beds. Patients currently inappropriately placed on acute admission wards should be relocated into more suitable accommodation, either in hospital or in the community. A range of provisions is required; simply providing more acute beds is not the answer. This study shows that there is a shortage of acute psychiatric beds and that this is related to both social deprivation and the overall availability of beds Over a quarter of inpatients were considered to be inappropriately placed on admission wards–for those with lengths of stay of more than six months this figure increased to 61% Lack of suitable accommodation, home based support, and rehabilitation places was identified as the major reason preventing discharge A range of hospital and community facilities is therefore required to address these problems of over-occupancy and shortages of acute beds