July 5, 2011

expert reaction to new research on reduction of mental illness beds and involuntary detention to be published in BMJ

Reaction to research on the association between provision of beds for patients with mental illnesses and rates of involuntary admissions in the NHS.

Prof Nick Craddock, Professor of Psychiatry, Cardiff University, said:

“Some politicians and managers seem more focused on reducing beds than improving care. However, all psychiatrists know that a carefully considered voluntary admission early in an illness can prevent a later emergency involuntary admission. The loss of beds makes this increasingly difficult.”

Prof Richard Morriss, Professor of Psychiatry and Community Mental Health, University of Nottingham, said:

“The relationship between the reduction in in-patient beds and increase in admissions under the Mental Health Act is unlikely to be a direct and causal one. Certainly opening up more in-patient beds now may not reduce the number of admissions under the Mental Health Act.

“However, both the reduction in in-patient beds and increase in admissions under the Mental Health Act, together with the rapid development of alternatives to admission such as crisis resolution, home treatment teams and assertive outreach teams, may reflect a priority in mental health services to avoid admission to hospital unless it is a last resort. This is not just for financial reasons, but also in the belief that people preferred to be in their own homes and lasting improvement is best obtained when treatment of acute mental illness occurs in the environment they live in rather than an artificial one, namely hospital.

“This might mean that admission to hospital is considered later than previously partly because of this priority and partly because mental health professionals know how difficult it can be to find an in-patient bed, particularly for someone who is not detained under the Mental Health Act. A study of carers of patients who were detained under the Mental Health Act (INVOLVe) reports that in some instances mental health services did delay admission to hospital and as a result the patient became worse and needed to be detained under the Mental Health Act.

“Given that the suicide rates in serious mental illness do not appear to be decreasing unlike those of the general population, there is a question to be asked whether mental health services have gone too far in their priorities in terms of keeping people at risk of suicide out of hospital.”

Dr James MacCabe MRCPsych, Senior Clinical Lecturer in Psychiatry, Institute of Psychiatry at King’s College London, said:

“With the drastic cuts in mental health beds, only the most disturbed patients can be admitted. Hospitals have been transformed from places of asylum, to toxic pressure cookers, which focus on containment rather than treatment. Deinstitutionalisation was a good thing but the pendulum has swung too far. Cutting beds even further will only exacerbate the problem.”

’Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study’ by Patrick Keown et al., published in the BMJ on 5 July 2011.