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UK Sees Increase In Psychiatric Admissions But Decrease In Available Beds
According to a study published on bmj.com,
there has been a marked increase in the number of compulsory admissions
to inpatient psychiatric care in the UK and a significant increase in
the number of patients that seek psychiatric care for alcohol and drug
problems. However, these increases have been accompanied by a decrease
in the number of NHS beds available.
Desinstitutionalization beginning in the 1950s left the country with
less than 55,000 psychiatric beds in 1995 compared to about 150,000 in
1955. Part of this is due to inpatient psychiatric care's high cost,
low popularity, and often mediocre results. Recent research,
though, has shown that involuntary admissions are on the rise, and we
may be entering a new era of reinstitutionalization.
In an investigation of how psychiatric care changed in England between
1996 and 2006, Patrick Keown (East Community Mental Health Team,
Newcastle upon Tyne) and colleagues analyzed data from the NHS
Information Centre, the Department of Health, and the 2006 'Count me
in' census.
A main finding of their research was that over a ten-year period, there
was a reduction in both total psychiatric admissions and NHS bed
numbers, but a 20% increase in the number of patients involuntarily
admitted. Keown and colleagues also noted a threefold increase in the
likelihood of admission to private facilities for these involuntary
patients.
Between 1996 and 2006, the proportion of NHS beds occupied
by patients admitted under a section of the mental health act
increased from 23% to 36%, respectively. During this same time period,
the researchers noted a 29% decrease in the number of psychiatric beds.
These "sectioned" patients were 15 times more likely to be in an NHS
facility than a private facility in 1996-7 but only five times more
likely by 2006.
In 1998, a peak of 214,000 patients was admitted to NHS for mental
disorders before these numbers began to fall. The reductions in
admissions were primarily driven by a 58% decrease in patients with
learning disabilities, a 33% decrease in patients with depression, and
a 28% decrease in patients with dementia. Although the number of
admissions for drug and alcohol problems has increase by 29% since
2003, admissions for those with schizophrenia and manic disorders have
remained pretty stable.
"Psychiatric inpatient care changed considerably from 1996 to 2006,
with more involuntary patients admitted to fewer NHS beds and
increasing proportions of involuntary patients admitted to private
facilities," conclude the authors. "The inpatient case mix has shifted
further towards psychotic and substance misuse disorders, which has
changed the milieu on inpatient psychiatric wards."
Professor
Scott Weich (Professor of Psychiatry at the University Warwick) argues
in an accompanying editorial that health care professionals should
focus on quality of supervision rather than numbers. "Global
bed numbers, like average rates of bed
occupancy, length of
stay, and needs
adjusted spending conceal
substantial - and poorly understood - differences between places and
service users," he writes. They also say nothing about the quality of
services and the experiences of users, carers, and staff.
Weich concludes: "Numbers
will always matter, but the greater need is for improvements in the
quality of services.
This will only happen if users' and carers' voices are heard and acted
on."
Retrospective analysis of hospital episode statistics,
involuntary admissions under the Mental Health Act 1983, and number of
psychiatric beds in England 1996-2006
Patrick Keown, Gavin Mercer, Jan Scott
BMJ (2008). 337:a1837
doi:10.1136/bmj.a1837
Click
Here to View Journal Web Site
Written by: Peter M Crosta
Copyright: Start Sanatate
Not to be reproduced without permission of Start Sanatate
Regatul Unit vede în creºtere de psihiatrie de admitere, dar în scãdere de paturi disponibile - UK Sees Increase In Psychiatric Admissions But Decrease In Available Beds - articole medicale engleza - startsanatate