Community In‐patient Care: Some Preliminary Findings from Northwest Wales
| Date | 01 March 2000 |
| Published date | 01 March 2000 |
| Pages | 17-20 |
| DOI | https://doi.org/10.1108/13619322200000005 |
| Author | Michael Carter,Alun Davies,Manikkarasa Devakumar |
| Subject Matter | Health & social care |
Community In-patient Care: Some Preliminary
Findings from Northwest Wales
Michael Carter
Research Psychologist, Northwest Wales NHS Trust
Alun Davies
General Manager, Northwest Wales NHS Trust
Manikkarasa Devakumar
Consultant Psychiatrist and Clinical Director,
Northwest Wales NHS Trust
Focus on…
Introduction
The interface between acute psychiatric in-patient
services and community-based services is becoming
the focus of increasing attention in terms of mental
health service development within the United
Kingdom. For some time Government policy has
emphasised the need for mental health services to
provide comprehensive care for people with a serious
mental illness (Department of Health, 1995; Welsh
Office, 1996). More recently the government’s
National Service Framework for Mental Health set
out a guiding principle that ‘services will deliver high
quality treatment and care which is known to be
effective and acceptable’ (Department of Health,
1999). A component of comprehensive care for people
with a serious mental illness has been and continues
to be the provision of viable alternatives to acute
psychiatric in-patient care. Within Northwest Wales
the impetus to develop alternatives to acute psychiatric
in-patient care derives from Mental Illness Services: A
Strategy for Wales (Welsh Office, 1989) and the multi-
agency document, Mental Illness Services: A Strategy for
Gwynedd (Gwynedd Health Authority et al., 1993).
One such alternative has been the development of
area support bed (ASB) units.
Area support beds
ASB units provide a major alternative to hospital
admission for people with a mental illness who require
intensive support. The facilities are a central feature
of the community-based mental health services in
Northwest Wales. In total there are three locality-
based ASB units serving a total population of
approximately 180,000 in a geographically rural area
covering some three-and-a-half thousand square
miles. Each ASB unit is managed by the NHS trust
with the service co-ordinated by the locality community
mental health team. In total there are 19 qualified
mental health staff and 18 health care assistants
staffing the ASB units.
Each ASB aims to provide a local alternative to
acute psychiatric hospital in-patient admission in the
form of planned admission, rehabilitation and respite
care. The basic rationale is to provide people who
might need psychiatric in-patient services with an
alternative community-based response and thereby
avoid an inappropriate admission to the DGH acute
psychiatric in-patient unit. Evidence that inappropriate
psychiatric hospital admissions do occur can be found
in a number of publications (Bebbington et al., 1992;
Tantam et al., 1992; Whittle, 1992; Audit Commission,
1994; The Sainsbury Centre for Mental Health, 1998).
There are also a number of studies which show that
a variety of community-based psychiatric services can
be an effective alternative to acute hospital-based
services (Test & Stein, 1980; Hoult, 1986; Muijen et al.,
1992; Merson et al., 1992; Dean et al., 1993; Burns et al.,
1993; Audit Commission, 1994; Marks et al., 1994;
Minghella et al., 1998). The main conclusion from
these studies is that community-based care can
reduce hospital admissions, improve psychiatric
symptomatology, increase employment opportunities,
improve relationships and increase the satisfaction
of users with the services. However, Marks (1992)
cautions that although the use of acute in-patient
services can be replaced and/or reduced it is not
possible to do without in-patient facilities.
The Mental Health Review Volume 5 Issue 1 March 2000 ©Pavilion Publishing (Brighton) 2000 17
To continue reading
Request your trial