Adult mental health provision in England: a national survey of acute day units

Danielle Lamb,Michael Davidson,Louise Marston,David Osborn,James Kirkbride,Jason Madan,Scott Weich,Sonia Johnson,Nicola Morant,Alastair Canaway,Vanessa Pinfold,Thomas Steare,Brynmor Lloyd-Evans,Samira Heinkel

doi:10.1186/s12913-019-4687-8

Abstract

BackgroundAcute Day Units (ADUs) exist in some English NHS Trusts as an alternative to psychiatric inpatient admission. However, there is a lack of information about the number, configuration, and functioning of such units, and about the extent to which additional units might reduce admissions. This cross-sectional survey and cluster analysis of ADUs aimed to identify, categorise, and describe Acute Day Units (ADUs) in England.MethodsEnglish NHS Mental Health Trusts with ADUs were identified in a mapping exercise, and a questionnaire was distributed to ADU managers. Cluster analysis was used to identify distinct models of service, and descriptive statistics are given to summarise the results of the survey questions.ResultsTwo types of service were identified by the cluster analysis: NHS (n = 27; and voluntary sector services (n = 18). Under a third of NHS Trusts have access to ADUs. NHS services typically have multi-disciplinary staff teams, operate during office hours, offer a range of interventions (medication, physical checks, psychological interventions, group sessions, peer support), and had a median treatment period of 30 days. Voluntary sector services had mostly non-clinically qualified staff, and typically offered supportive listening on a one-off, drop-in basis. Nearly all services aim to prevent or reduce inpatient admissions. Voluntary sector services had more involvement by service users and carers in management and running of the service than NHS services.ConclusionsThe majority of NHS Trusts do not provide ADUs, despite their potential to reduce inpatient admissions. Further research of ADUs is required to establish their effectiveness and acceptability to service users, carers, and staff.

Highlights

Acute Day Units (ADUs) exist in some English NHS Trusts as an alternative to psychiatric inpatient admission
Existing crisis care provided by inpatient wards and Crisis Resolution Teams (CRTs) can be augmented by ADUs, which may be helpful for people who are socially isolated or have poor social support, lack activities, or who would benefit from peer support or group interventions
Of the 45 ADUs identified, 27 (60%) were in NHS Trusts (17 Trusts, 29% of the 58 mental health Trusts in England) eight were joint NHS/voluntary sector services (17%), and ten were voluntary sector services (23%)

Summary

Introduction

Acute Day Units (ADUs) exist in some English NHS Trusts as an alternative to psychiatric inpatient admission. There are well-established challenges facing acute mental health care for people experiencing crises These include: poor experience of services, lack of provision of recommended interventions, delays in accessing care, poor continuity of care, over-reliance on restriction orders, use of police for conveyance, overcrowding in Emergency Departments, and continuing issues with reduced bed capacity [2, 3]. This is a world-wide problem, and a range of reports have highlighted the need for. Acute Day Units (ADUs) have the potential to address these challenges These units offer intensive, short-term community responses to mental health crises, and aim to reduce costly and unpopular admissions, either avoiding them or facilitating early discharge. Existing crisis care provided by inpatient wards and Crisis Resolution Teams (CRTs) can be augmented by ADUs, which may be helpful for people who are socially isolated or have poor social support, lack activities, or who would benefit from peer support or group interventions

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Results

Conclusion