Old age psychiatrists' views on continuing in-patient care

Abstract

Aims and methodsThe aim of this study was to elicit views from UK consultants in old age psychiatry concerning changes that were taking place in long-term care for older people with mental illness (especially dementia) and their views on a draft consensus statement produced by the Faculty for Psychiatry of Old Age on behalf of the College. A postal questionnaire was circulated as part of a wider survey of 472 consultants and a single postal reminder was sent to non-responders.ResultsTwo hundred and forty-two (51%) consultants responded. Nearly nine out of 10 respondents were in favour of continuing NHS consultant-supervised long-stay beds and three-quarters of them preferred a return to national numerical guidelines for bed numbers, though at a level approximately half of previous guidelines and provision. This was accompanied by a view that such beds should no longer be ‘for life’ with over three-quarters of respondents supporting discharge if, for example, behaviour problems resolved. If Government policy continued to support ‘eligibility criteria’ rather than guidelines, 60% were in favour of national rather than local criteria. There was very strong support for the draft consensus statement (now published in modified form as College Policy) and the ‘eligibility criteria’ it contained. Agreed criteria for waiting times in acute beds for continuing NHS, nursing home or residential care were not widely used.Clinical implicationsConsultants want to continue to be responsible for some longer-term care and efforts should be made to develop the role of NHS longer-term care within the 'spectrum of services' provided for older people with psychiatric disorder, perhaps by acting as local ‘centres of excellence’ in dementia care as well as by providing services for patients with the more difficult behavioural problems. The more widespread use of ‘agreed waiting times' for patients in acute beds requiring longer-term care should be explored.