Skip to main content Accessibility help
×
Home

System failure? The problems of reductions in long-stay beds in the UK1

  • Geoff Shepherd (a1)

Summary

Objective — To review the relevant literature on the effects of reductions in long stay beds on mental health services in the UK. Method — A selective literature review, with particular reference to research conducted by the author and colleagues at The Sainsbury Centre for Mental Health.Results — The evidence suggests that the effects of long stay bed reductions should be examined with regard to 'old' and 'new' long stay patients separately. While the 'old' long stay who have been most directly effected by these changes have generally fared well; the 'new' long stay have not. They are currently accumulating in acute inpatient units, often on general hospital sites, or are rotating in the 'revolving door' of acute inpatient care and inadequate community supports. Although it is clear that there is a shortage of acute beds especially in inner city areas many of the these beds are currently occupied by patients who would be better (and less expensively) cared for in community alternatives if these were available. The evidence suggests that it is possible to im-prove outcomes for this 'new' long stay group if specific kinds of housing, work and assertive community teams are provided. Conclusions — It is concluded that the effects of long stay bed reductions should be considered in a 'systems perspective'. Effective community services can be established, but in order to achieve effective substitution of one kind of service for another, there must be a well co-ordinated, clearly targeted, and technically efficient system. At the present time such services are rare. However, simply focusing on one element (e.g. beds) is unlikely to produce cost effective and efficient solutions.

Scopo — Esaminare la letteratura riguardante gli effetti della riduzione del numero di letti per lungodegenti nei Servizi di Salute Mentale della Gran Bretagna. Metodo — Revisione selettiva della letteratura, con particolare riferimento a ricerche condotte dall'autore e dai suoi colleghi presso il Sainsbury Centre for Mental Health.Risultati — Le evidenze suggeriscono che gli effetti della riduzione dei letti dei lungodegenti dovrebbero essere esaminati separatamente, distinguendo i «vecchi» dai «nuovi» lungodegenti. Mentre i «vecchi» lungodegenti, che sono stati più direttamente toccati da questi cambiamenti, hanno avuto generalmente risultati positivi, lo stesso non può dirsi per i «nuovi» lungodegenti. Questi pazienti vengono correntemente accumulati in Unità per pazienti gravi, spesso in reparti di ospedali generali o entrano nel meccanismo della «porta girevole», che è rappresentato dai trattamento dei pazienti acuti a cui segue un inadeguato supporto sociale. Nonostante sia evidente la scarsita di letti per acuti, specialmente nelle aree centrali delle città, molti di questi letti sono attualmente occupati da pazienti che sarebbero curati meglio (e con minore spesa) in strutture territoriali alternative, se esse fossero disponibili. Le evidenze suggeriscono che e possibile migliorare gli esiti per questo gruppo di «nuovi» lungodegenti, se fossero utilizzabili specifici team territoriali che si occupino di reperire alloggi e lavoro e di assicurare adeguato sostegno. Conclusioni — Gli effetti della riduzione dei letti di pazienti lungoassistiti dovrebbero essere considerati in una prospettiva sistemica. Si possono organizzare servizi sociali efficaci, ma, per ottenere una efficace sostituzione di un tipo di servizio con un altro, ci deve essere un sistema ben coordinato, con obiettivi definiti e tecnicamente efficiente. Attualmente tali tipi di servizi sono rari. Comunque è improbabile che mettere a fuoco semplicemente un singolo elemento del sistema (ad esempio, il numero di letti) produca soluzioni efficaci ed efficienti.

Copyright

Corresponding author

Indirizzo per la corrispondenza: Professor G. Shepherd, HAS 2000, 11 Grosvenor Crescent, London SW1X 7EE (UK). Fax +44 (0)171-245.0428.

Footnotes

Hide All
1

Relazione presentata su invito al Terzo Congresso Nazionale della Società Italiana di Epidemiologia Psichiatrica (Milano 19-Novembre 1997).

Footnotes

References

Hide All
Bachrach, L.L. (1976). Deinstitutionalisation: An Analytical Review and Sociological Perspective. US Department of Health, Education and Welfare: Maryland.
Beecham, J., Hallam, A., Knapp, M., Baines, B., Fenyo, A. & Asbury, M. (1997). Costing care in hospital and in the community. In Care in the Community. Illusion or Reality? (ed. Leff, J.). Wileys: Chichester.
Bond, G.R., Drake, R.E., Mueser, K.T. & Becker, D.R. (1997). An update on supported employment for people with severe mental illness. Psychiatric Services 48, 335346.
Burns, B.J. & Santos, A.B. (1995). Assertive community treatment: an update of randomized trials. Psychiatric Services 46, 669675.
Curtis, R. & Beevor, A. (1995). Health of the Nation Outcome Scales (HONOS). In Measurement for Mental Health (ed. Wing, J.). Royal College of Psychiatry: London.
Drury, V., Birchwood, M., Cochrane, R. & Macmillan, F. (1996a). Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms. British Journal of Psychiatry 169, 593601.
Drury, V., Birchwood, M., Cochrane, R. & Macmillan, F. (1996b). Cognitive therapy and recovery from acute psychosis: a controlled trial. II. Impact on recovery time. British Journal of Psychiatry 169, 602607.
Ford, R., Ryan, P., Norton, P., Beadsmoore, A., Craig, T. & Muijen, M. (1996). Does intensive case management work? Clinical, social and quality of life outcomes from a controlled study. Journal of Mental Health 5, 361368.
Geddes, J.R., Game, D., Jenkins, N.E., Peterson, L.A., Pottinger, G.R. & Sackett, D.L. (1996). What proportion of primary psychiatric interventions are based on evidence from randomised controlled trials? Quality in Health Care 5, 215217.
Grove, R., Freudendberg, M., Harding, A. & O'Flynn, D. (1997). The Social Firm Handbook. Pavilion: Brighton.
Hoult, J., Reynolds, I., Charboneau-Powis, M., Weekes, P. & Briggs, J. (1983). Psychiatric hospital versus community treatment: the results of a randomised trial. Australian & New Zealand Journal of Psychiatry 17, 160167.
Kings Fund (1997). London's Mental Health. Kings Fund: London.
Kluiter, H. (1997). Inpatient treatment and care arrangements to replace or avoid it searching for an evidence-based balance. Current Opinion in Psychiatry 10, 160167.
Knapp, M., Beecham, J. & Hallam, A. (1997). The mixed economy of psychiatric reprovision. In Care in the Community. Illusion or Reality? (ed. Leff, J.). Wiley: Chichester.
Leff, J. (1997). Care in the Community. Illusion or Reality? Wiley: Chichester.
Lelliot, P. & Wing, J.K. (1994). A national audit of new long-stay psychiatric patients. II: Impact on services. British Journal of Psychiatry 165, 170178.
Lelliot, P., Wing, J.K. & Clifford, P. (1994). A national audit of new long-stay psychiatric patients. I: Method and description of the cohort. British Journal of Psychiatry 165, 160169.
Linszen, D., Dingeman, P., Van Der Does, J.M., Nugter, A., Scholte, P., Lenoir, R. & Goldstein, M. (1996). Treatment, expressed emotion and relapse in recent onset schizophrenia disorders. Psychological Medicine 26, 565578.
Rose, D. & Muijen, M. (1997). Nursing doubts. Health Services Journal 107, 3435.
Ritchie, J.H., Dick, D. & Lingham, R. (1994) The Report of the Inquiry into the Care and Treatment of Christopher Clunis. HMSO: London.
Shepherd, G. (1997). Vocational rehabilitation in psychiatry. An historical perspective. In The Social Firm Handbook (ed. Grove, R., Freudendberg, M., Harding, A. and O'Flynn, D.). Pavilion Press: Brighton.
Shepherd, G. (1998). Social functioning and challenging behaviour. In Social Functioning and Schizophrenia (ed. Meuser, K.T. and Tarrier, N.). Allyn Bacon: New York.
Shepherd, G., Muijen, M., Dean, R. & Cooney, M. (1995). Inside Residential Care: The Realities of Hospital versus Community Settings. Sainsbury Centre for Mental Health: London.
Shepherd, G., Muijen, M., Dean, R. & Cooney, M. (1996). Residential care in hospital and in the community. Quality of care and quality of life. British Journal of Psychiatry 168, 448456.
Shepherd, G., Beadsmoore, A., Moore, C., Hardy, P. & Muijen, M. (1997). Relation between bed use, social deprivation, and overall bed availability in acute adult psychiatric units, and alter-native residential options: a cross sectional survey, one day census data and staff interviews. British Medical Journal 262266.
Tanzman, B. (1993). An overview of surveys of mental health consumers' preferences for housing and support services. Hospital and Community Psychiatry 44, 450455.
Teague, G.B., Drake, R.E. & Ackerson, T.H. (1995). Evaluating use of continuous treatment teams for persons with mental illness and substance abuse. Psychiatric Services 46, 689695.
Warner, R. (1985). Recovery from Schizophrenia. Routledge & Kegan Paul: London.
Young, R. (1991). Residential Needs of Severely Disabled Psychiatric Patients. The Case for Hospital Hostels. HMSO: London.

Keywords

System failure? The problems of reductions in long-stay beds in the UK1

  • Geoff Shepherd (a1)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed