Community hospitals: a solution to the stigma and dislocation of acute inpatient hospital admission
| Published date | 01 March 2007 |
| Pages | 6-9 |
| DOI | https://doi.org/10.1108/17465729200700002 |
| Date | 01 March 2007 |
| Author | Hefin Gwilym |
| Subject Matter | Health & social care |
This paper looks at the evolving nature of mental health services.While there has been a shift from
asylums to care in the community in recent decades, what is now needed is another shift of acute
inpatient psychiatric care, away from psychiatric units to community hospitals and other community
settings. It is argued that this would be a further step forward in the evolution of mental health
services as it would benefit the ser vice users,their families, carers and staff working in acute psychiatric
inpatient units.
Community hospitals:
asolution to the stigma
and dislocation of acute
inpatient hospital admission
Hefin Gwilym
Lecturer in social work
School of
Social Sciences
University of Wales
Correspondence to:
Hefin Gwilym
School of
Social Sciences
University of Wales
Bangor,Gwynedd
LL57 2DG
sos402@bangor.ac.uk
OPINION
6journal of public mental health
vol 6 • issue 1
The experience of patients in psychiatric
hospitals over the years leaves much to
be desired. In the old asylums, many
patients were left virtually forgotten on
back wards for many years. When these
asylums were closed down in favour of smaller acute
psychiatric units, it was not unusual to find people
who had been there for as long as 30 years (Crosby
et al, 1995). It was also not unusual to find people
who had been incarcerated for many years and had
no mental health problem: many had been admitted
years previously because of what was seen as
immoral behaviour, such as having a child out of
wedlock (Murphy, 1991).
There have been important changes in recent
years in protecting patients’ rights. This has been
helped by legislation, such as the Mental Health Act
1983, which introduced measures to guard against
patients being held indefinitely in psychiatric
hospitals. Reform of mental health services over the
last 20 years has focused on shifting the locus of care
from the hospital to community settings. The closure
of the large asylums and the opening of acute
psychiatric inpatient units on, usually,the site of
general hospitals, meant that inpatient care took a
step closer to the patients’ homes and communities.
Interestingly,the closure of the large asylums has
not necessarily meant a reduction in psychiatric
admissions. When the North Wales Psychiatric
Hospital in Denbigh was closed in 1995, the number
of long-term inpatient beds in North Wales
decreased, but the number of admissions to the new
psychiatric inpatient units increased (Michael, 2003).
Despite the progress made in some areas, many
problems remain in the organisation of care for
psychiatric inpatients. I worked as a social worker in
acommunity mental health team and in an
extended hours mental health service in a rural area
of north west Wales between 1999 and 2004. During
this time I became aware of the experiences of
patients from rural areas, and the challenges they
pose for policy makers and senior NHS managers
alike. Two of the greatest problems were those of
distance and travel between the patient’s home and
the acute psychiatric unit. In rural areas these units
may be as much as 60 miles from the patient’s home,
family and community. Even a distance of 30 miles
can take well over an hour to travel through narrow
country roads – a situation made worse during the
summer months when the population in the area
can double with the influx of holiday makers. It is
also a strain on families who have to travel long
distances to see their relatives. There are great
financial costs involved here, especially if the
patient is admitted for many weeks and family
members want to visit them every day. The
©Pavilion Journals (Br ighton) Ltd
Keywords
community
hospitals
acute inpatient
psychiatric units
community mental
health care
Wales
stigma
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