Publication Date13 February 2017
Date13 February 2017
AuthorRachel Perkins,Julie Repper
SubjectHealth & social care,Mental health,Social inclusion
Rachel Perkins and Julie Repper
Mental health support in crisis: bed shortages or lack of community suppor t?
The crisis in mental health crisis care has been widely reported.
Many people who experience mental health crises, and their relatives, have spoken about the
difficulties they have experienced in accessing help when they need it (see, e.g. Mind, 2011).
Many have also described how they feel that they have been batted away: told that they were
not ill enoughto warrant crisis care.
In a survey reported by the Commission to Review the Provision of Acute Inpatient Psychiatric Care
for Adults (The Commission to Review the Provision of Acute Inpatient Psychiatric Care For Adults
(CAAPC), 2015), to which 79 per cent of mental health trusts in England responded, average bed
occupancy was 104 per cent. This results in many people being placed in beds far from theirhomes:
Current estimates suggest that each month around 500 mentally ill people have to travel over 50km to
be admitted into hospitals far from their own homes (The Commission to Review the Provision of
Acute Inpatient Psychiatric Care for Adults (CAAPC), 2016).
Even when a bed can be found, the shortcomings in care provided on many inpatient wards has also
been widely reported (see, e.g. Mind, 2011; Centre for Social Justice, 2011; CAAPC, 2015, 2016):
Quality of life on the ward wasterrible, it was a violentplace to be. I was repeatedlyhit and had things
stolenbut most of thenurses did not care.The hospital wasfilthy and the staffstressed andover-worked,
access to different therapies was non-existent. They moved my bed eighttimes in four weeks!
All staff time and resources are spent to stop bad things happening but not make good things happen
(Mind, 2011, p. 22).
Some have argued that shortages of beds have resulted in more compulsory detentions. The
number of compulsory detentions has indeed reached record highs. 2014/2015 saw the largest
year on year increase ever in compulsory detentions of 10 per cent to 58,399 and 2015/2016
saw a 9 per cent increase to 63,622. This represents an increase of 47 per cent 20,261
detentions over the ten years since 2005/2006 (43,361)[1].
The response has often been to call for more inpatient psychiatric beds. However, this may not
be where the real problem lies.
While it istrue that the number of acute inpatientbeds has decreased (bysome 2,100 since 2010
see McNicholl, 2015a) acute inpatient beds cannot be considered in isolation from community
services. During the same time period, crisis and home treatment teams saw a cut of 8 per cent
and an increasein demand of 18 per cent, early interventionin psychosis teams saw a 26 per cent
cut and assertive outreach teams saw a 56 per cent cut (McNicholl, 2015a, b). Many assertive
outreachteams have been dismantled with their functionsbeing integrated intoCommunity Mental
Health Teams (CMHTs). However, these CMHTs have undergone considerable reconfiguration
and remodellingin recent years (Gilbert,2015) and themselves saw a smallcut (0.6 per cent) and a
large increase in demand (19 per cent) (McNicholl, 2015a,b):
Any problems with community service provision can create significant pressure on acute inpatient
beds (Gilbert, 2015, p. 7).
In their survey of acute psychiatric inpatient wards, CAAPC (2015) reported that:
The main factors affecting pressures on beds were availability of housing (39%) and quality/resourcing
of community teams (30%).
The majority of consultant psychiatrists who were responsible for inpatient psychiatric
beds agreed, saying either that they had enough beds, or that they would have enough
DOI 10.1108/MHSI-12-2016-0039 VOL. 21 NO. 1 2017, pp. 1-4, © Emerald Publishing Limited, ISSN 2042-8308

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