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

  • Geoff Shepherd (a1)


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.


Corresponding author

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


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



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

  • Geoff Shepherd (a1)


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