(originally posted on the UoN Blog on 17 October 2013)
Why is a leading psychiatrist concerned about not having the resources needed to provide psychiatric care? Martin Baggaley, South London and Maudsley’s clinical director hit the headlines this week when he stated that too many psychiatric beds had been closed. It is possible to specify fairly precisely how many beds are sufficient to meet the needs of people with severe mental illness. After all, the prevalence of mental disorders can be estimated within reasonable parameters, based on nationally representative surveys and mental health services have masses of data about readmission rates and co-morbidity, and clinical commissioning groups should have this information. In fact it is not bed numbers, but the balance of community and hospital provision that is at issue here, and data collated for a European study led by the Institute of Mental Health, Nottingham throw light on this balance.
The UK is a world leader in community care. Whereas some other countries, including Belgium and Malta, rely almost entirely on psychiatric hospitals to provide mental health care, for half a century in the UK we have had a strong bias against hospital admission because of its associated stigma, costs and the risk of institutionalisation that long-term admissions are believed to pose. Responsive, community-based services were developed to span all levels of complexity, from early intervention in psychosis to home treatment for people in crisis. These comprehensive services have been adversely affected by the cost improvement plans imposed on all providers. It’s easy to count beds and I don’t disagree that the numbers have been sharply reduced in recent years. However, as Martin Baggaley states, the shortage of beds is part of a general reduction in mental health and social care provision, it’s one of a swathe of so-called ‘cost improvements’.
Given the recent history of mental health services, it is not surprising that, of 29 European countries, the UK has the ninth lowest number of psychiatric beds per capita. But it is remarkable that, according to WHO European Hospital Morbidity Database (2012), people admitted to hospital in the UK with schizophrenia (for instance) on average spend nearly four months as inpatients – twice as long as most other countries in Europe. We need to understand more about these long-term hospital admissions and why the limited inpatient resource seems to have an exceptionally low throughput.
This is a guest blog by Professor Justine Schneider (pictured above), an expert in mental health service evaluation and dementia care in the University’s School of Sociology and Social Policy. This blog draws on a new report ‘Mental health Systems in the European Union Member States, Status of Mental Health in Populations and Benefits to be Expected from Investments into Mental Health’ by Chiara Samele, Stuart Frew and Norman Urquia, 2013.