Bed Crisis Research Articles

Crisis beds: the interface between the hospital and the community.

The main role of the crisis unit at a state psychiatric hospital was found to be the provision of brief hospitalisation for patients with adjustment disorders and personality disorders. The four bed crisis unit treated 14% of all patients admitted to the hospital, with an average length of stay less than three days. A study of 78 crisis unit patients found that 77% were able to be discharged directly to the community, and only 18% were readmitted during the following six months.

Bed crisis in mental health

Bed crisis in mental health

The continuing rise in emergency admissions

Emergency admissions in Britain are continuing to rise.1 The highly publicised bed crisis this winter and a number of national meetings have underlined concern over the lack of explanations and frustration at the lack of control. In Scotland, emergency admissions increased by 45% between 1981 and 1994 (fig 1). This represented an annual increase of about 3%, rising to over 5% in 1993 and 1994,2 and probably in 1995. Even steeper increases have been reported by individual hospitals throughout Britain.1 2 In stark contrast, elective admissions have increased by only 1% a year.3 Emergency hospital admissions account for about 40% of total acute bed use in the NHS.2 Trends in elective and emergency admissions in Scotland Why is this rise occurring? Potential explanations need to account for its generality and persistence. Hospital admissions have actually been increasing for some four decades.1 3 Some recent inflation in the figures was caused by the use of finished consultant episodes and more complete recording. However, analysis of linked data has confirmed that the rise is genuine.2 Only 2% of the increase can be explained by population aging.1 2 Although all age groups and diagnostic categories are involved in …

Scottish bed crisis leads to review on planning services

Scottish bed crisis leads to review on planning services

BMA warns of bed crisis in the NHS

BMA warns of bed crisis in the NHS

Resolving London's bed crisis: there might be a way, is there the will?

is the day to day happenings that underlie the MILMIS indicators that are most shocking; these were not captured directly by the survey but came in the form of anecdotes from participants. Some have been highlighted by other commentators (Watson, 1994; Hollander & Slater, 1994). It is common for there to be no admission beds available at all in the South of England. In these circumstances patients, who may be highly distressed or disturbed, may have to be nursed for 24 or even 36 hours In a room in an accident and emergency department while doctors or nurses make numerous phone calls to locate a bed, often at a hospital many miles outside of London. There have been instances where suicidal or dangerous patients have absconded while waiting and others where patients, who would have accepted voluntary admission to their local unit, have had to be compulsorily admitted because they did not wish to go to the distant hospital. While the immediate care of those admitted to distant hospitals may well be adequate, this situation makes a mockery of trust mission statements and commissioning plans that talk of local and accessible services and integration between hospital and community. While not advocating a return to the asylum, it would be difficult to argue that to admit a London resident to a hospital on the south coast is any advance from the days when such patients would have been admitted to the large psychiatric hospitals that ringed London; at least these hospitals had established channels of communication with the local facilities. The MILMIS indicators that relate to ward conditions almost certainly reflect a vicious circle, part of which was described by the Audit Commission (1994). High admission thresholds and few beds concentrate severely ill people on acute units, creating a culture of violence and sexual harassment. Such living conditions are intolerable and not surprisingly many patients will not accept them; those who are not safe to be in the community therefore have to be compulsorily admitted to keep them in hospital (one half of patients were detained under the Mental Health Act; in one service the proportion was two-thirds). In this highly charged atmosphere, containment Is the priority for staff, rather than therapy, rehabilitation and resettlement. This, coupled with inadequate community provision, particularly access to high staffed hostels, delays discharge and further blocks beds (Lelliott & Wing, 1994). Were service planners to design an environment for the treatment of people with schizophrenia on the basis of what is known about the social and environmental factors that contribute to health in such people, the results would certainly not resemble a London psychiatric admission ward. The MILMIS findings about conditions in hospital wards perhaps go some way to explaining why patients prefer community based alternatives to hospital care (Muijen et cd, 1992). Although the MILMIS indicators do not directly inform the debate as to how to resolve the problem for London services, most commentators agree that reducing bed occupancy levels would be an essential element to any plan, but how should this be achieved? The debate has become polarised between those who advocate the apparently simple expedient of creating more beds (e.g. Watson, 1994) and those who hold that the solution lies in creating more effective community services